Carotid cavernous sinus fistula with central retinal artery occlusion: A case report

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Chonwarat Phattarapongdilok
Suntaree Thitiwichienlert



Background: A carotid-cavernous sinus fistula (CCF) is an abnormal arteriovenous communication between the cavernous sinus and the internal carotid artery (ICA) and/or external carotid artery (ECA). Central retinal artery occlusion (CRAO) is a rare posterior segment complication following CCF.

Case Report: We present a 58-year-old female complaining of acute visual loss, redness and swelling of the right eye following a motor vehicle accident. Her visual acuity was light perception (PL) in the right eye and 20/40 in the left eye. The intraocular pressure (IOP) was 52 mmHg in the right eye and normal in the left eye. Eye examinations revealed proptosis, ptosis, complete total ophthalmoplegia and a 5 mm fixed dilated right pupil with relative afferent pupillary defect (RAPD) positive in her right eye. Fundus examination showed CRAO in the right eye. Cerebral angiography revealed a high flow direct CCF Barrow’s type A. Endovascular treatment with balloon embolization was performed. During the 1-year follow-up, the patient had improvement of eye redness, proptosis and ophthalmoplegia. However, the visual prognosis was poor due to optic atrophy and macular ischemia with the final visual acuity of PL.

Conclusion: CRAO is a rare complication of traumatic CCF. Traumatic CCF often require endovascular treatment and early recognition of CRAO are of clinical importance.

Conflict of interest: none.

Keywords: carotid cavernous sinus fistula, central retinal artery occlusion, endovascular treatment




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