We report an interesting case of a spontaneous occlusion of a carotid cavernous fistula (CCF) causing a paradoxical worsening of orbital symptoms. A 59-year-old woman presented to our institution with conjunctival injection, raised intraocular pressures (IOP) and mild exophthalmos of her left eye. A digital subtraction angiography (DSA) demonstrated a Type-D CCF draining into the left superior ophthalmic vein (SOV). The patient declined endovascular treatment. She presented 15 months later with acute exacerbation of her orbital signs and symptoms. A DSA showed no evidence of arteriovenous fistula, and a brain MRI was consistent with spontaneous thrombosis of the SOV. At her 2-week clinical assessment, the patient showed clinical improvement and her IOP were within normal limits. Spontaneous thrombosis of the SOV can trigger the obliteration of a CCF with possible paradoxical worsening of orbital symptoms. DSA is the gold standard of diagnosis and management is directed toward decreasing IOP.
We present an interesting case of a type-D carotid cavernous fistula (CCF) that closed spontaneously with a paradoxical worsening of the symptoms due to thrombosis of the superior ophthalmic vein (SOV). The authors also give directives for the management of these extremely rare cases.
Gonzalez, MD, L. Fernando; Bilyk, MD, Jurij R.; Jabbour, MD, Pascal; Tjoumakaris, MD, Stavropoula; Dumont, MD, Aaron S.; Chalouhi, MD, Nohra; and Rosenwasser MD, Robert H.
"Paradoxical Worsening of Ocular Symptoms after Spontaneous Closure of a Carotid Cavernous Fistula: Case Report,"
JHN Journal: Vol. 7
, Article 3.
Available at: http://jdc.jefferson.edu/jhnj/vol7/iss1/3