The
n e w e ng l a n d j o u r na l
of
m e dic i n e
images in clinical medicine Lindsey R. Baden, M.D., Editor
Carotid Cavernous Fistula A
B Cavernous sinus
Cavernous part of internal carotid artery Internal carotid artery Fistula
D
C
Superior ophthalmic vein
Coils
Cavernous internal carotid artery
Cavernous sinus
Sudhir Venkataramaiah, M.B., B.S., M.D. Kamath Sriganesh, M.B., B.S., M.D., D.M. National Institute of Mental Health and Neurosciences Bangalore, India [email protected]
A
26-year-old man with a history of blunt trauma to the head 2 months earlier presented with rapidly progressive swelling, pain, and diminishing vision in the left eye. The physical examination of the left eye revealed chemosis, pulsating proptosis, and an ulcerated cornea (Panel A). A bruit could be heard with a stethoscope placed on the left temple. Selective angiography of the left carotid artery showed a fistulous communication between the internal carotid artery and the cavernous sinus (Panel B, lateral projection) and early filling of the superior ophthalmic vein (Panel C, lateral projection). Under general anesthesia, the patient underwent endovascular coiling of the fistula (Panel D). At 6 months after the coiling procedure, there was a 95% reduction in the patient’s proptosis. Carotid cavernous fistula is an abnormal arteriovenous communication between the carotid artery or its branches and the cavernous sinus. It can result from blunt trauma to the skull. As arterial blood enters the cavernous sinus under high pressure, normal venous return is impeded, leading to engorgement of the draining veins. The mainstay of therapy is endovascular occlusion of the affected cavernous sinus with coils, glue, or balloons.
DOI: 10.1056/NEJMicm1311966 Copyright © 2014 Massachusetts Medical Society.
1832
n engl j med 371;19
nejm.org
november 6, 2014
The New England Journal of Medicine Downloaded from nejm.org on November 19, 2014. For personal use only. No other uses without permission. Copyright © 2014 Massachusetts Medical Society. All rights reserved.
n e w e ng l a n d j o u r na l
of
m e dic i n e
images in clinical medicine Lindsey R. Baden, M.D., Editor
Carotid Cavernous Fistula A
B Cavernous sinus
Cavernous part of internal carotid artery Internal carotid artery Fistula
D
C
Superior ophthalmic vein
Coils
Cavernous internal carotid artery
Cavernous sinus
Sudhir Venkataramaiah, M.B., B.S., M.D. Kamath Sriganesh, M.B., B.S., M.D., D.M. National Institute of Mental Health and Neurosciences Bangalore, India [email protected]
A
26-year-old man with a history of blunt trauma to the head 2 months earlier presented with rapidly progressive swelling, pain, and diminishing vision in the left eye. The physical examination of the left eye revealed chemosis, pulsating proptosis, and an ulcerated cornea (Panel A). A bruit could be heard with a stethoscope placed on the left temple. Selective angiography of the left carotid artery showed a fistulous communication between the internal carotid artery and the cavernous sinus (Panel B, lateral projection) and early filling of the superior ophthalmic vein (Panel C, lateral projection). Under general anesthesia, the patient underwent endovascular coiling of the fistula (Panel D). At 6 months after the coiling procedure, there was a 95% reduction in the patient’s proptosis. Carotid cavernous fistula is an abnormal arteriovenous communication between the carotid artery or its branches and the cavernous sinus. It can result from blunt trauma to the skull. As arterial blood enters the cavernous sinus under high pressure, normal venous return is impeded, leading to engorgement of the draining veins. The mainstay of therapy is endovascular occlusion of the affected cavernous sinus with coils, glue, or balloons.
DOI: 10.1056/NEJMicm1311966 Copyright © 2014 Massachusetts Medical Society.
1832
n engl j med 371;19
nejm.org
november 6, 2014
The New England Journal of Medicine Downloaded from nejm.org on November 19, 2014. For personal use only. No other uses without permission. Copyright © 2014 Massachusetts Medical Society. All rights reserved.
![[Carotid-cavernous fistula: clinical and pathological correlations].](/assets/img/hold.png)
