open access

Vol 7 (2022): Continuous Publishing
Case report
Published online: 2022-03-17
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Ophthalmological presentation of carotid cavernous fistulas: case series and a paradigmatic case report

Carla Fernandes1, João Ramos2, Pedro Arede1, Carolina Bruxelas1, Gabriel Branco2, Cristina Branco2, João Costa1
·
Ophthalmol J 2022;7:46-50.
Affiliations
  1. Ophthalmology Department, Hospital Egas Moniz, Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal
  2. Neuroradiology Department, Hospital Egas Moniz, Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal

open access

Vol 7 (2022): Continuous Publishing
CASE REPORTS
Published online: 2022-03-17

Abstract

The purpose of this paper is to describe the clinical presentation of carotid cavernous fistulas (CCFs) managed in Hospital Egas Moniz between January 2010 and December 2020. Patients presenting with orbital congestive signs or symptoms with an ophthalmological evaluation and a diagnosis of CCF confirmed by digital subtraction angiography were included retrospectively. Carotid cavernous fistulas are rare and difficult to diagnose. Direct CCFs tend to have a more severe, acute onset presentation, while indirect CCFs are associated with a more insidious onset and chronic course. Anterior and inferior drainages are the most common in both direct and indirect CCF. Clinical presentation can be varied and nonspecific; however, patients commonly present with ophthalmological manifestations.

All of our case series patients presented with ophthalmological complaints. The most frequently seen signs or symptoms were red eye (n = 8), increased intraocular pressure (IOP) (n = 8), and ophthalmoparesis with diplopia (n = 7).

Abstract

The purpose of this paper is to describe the clinical presentation of carotid cavernous fistulas (CCFs) managed in Hospital Egas Moniz between January 2010 and December 2020. Patients presenting with orbital congestive signs or symptoms with an ophthalmological evaluation and a diagnosis of CCF confirmed by digital subtraction angiography were included retrospectively. Carotid cavernous fistulas are rare and difficult to diagnose. Direct CCFs tend to have a more severe, acute onset presentation, while indirect CCFs are associated with a more insidious onset and chronic course. Anterior and inferior drainages are the most common in both direct and indirect CCF. Clinical presentation can be varied and nonspecific; however, patients commonly present with ophthalmological manifestations.

All of our case series patients presented with ophthalmological complaints. The most frequently seen signs or symptoms were red eye (n = 8), increased intraocular pressure (IOP) (n = 8), and ophthalmoparesis with diplopia (n = 7).

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Keywords

ophthalmology; carotid cavernous fistulas; clinical presentation

About this article
Title

Ophthalmological presentation of carotid cavernous fistulas: case series and a paradigmatic case report

Journal

Ophthalmology Journal

Issue

Vol 7 (2022): Continuous Publishing

Article type

Case report

Pages

46-50

Published online

2022-03-17

Page views

4935

Article views/downloads

581

DOI

10.5603/OJ.2022.0007

Bibliographic record

Ophthalmol J 2022;7:46-50.

Keywords

ophthalmology
carotid cavernous fistulas
clinical presentation

Authors

Carla Fernandes
João Ramos
Pedro Arede
Carolina Bruxelas
Gabriel Branco
Cristina Branco
João Costa

References (12)
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  2. Williams ZR. Carotid-Cavernous Fistulae: A Review of Clinical Presentation, Therapeutic Options, and Visual Prognosis. Int Ophthalmol Clin. 2018; 58(2): 271–294.
  3. Iampreechakul P, Tirakotai W, Tanpun A, et al. Spontaneous resolution of direct carotid-cavernous fistulas: case series and literature review. Interv Neuroradiol. 2019; 25(1): 71–89.
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  8. Marques MC, Caldas JG, Nalli DR, et al. Follow-up of endovascular treatment of direct carotid-cavernous fistulas. Neuroradiology. 2010; 52(12): 1127–1133.
  9. Henderson AD, Miller NR. Carotid-cavernous fistula: current concepts in aetiology, investigation, and management. Eye (Lond). 2018; 32(2): 164–172.
  10. Thiyagarajam K, Chong MF, Mohd Khialdin S. The Diagnostic Challenges in Carotid Cavernous Fistula: A Case Series. Cureus. 2021; 13(11): e19696.
  11. de Keizer R. Carotid-cavernous and orbital arteriovenous fistulas: ocular features, diagnostic and hemodynamic considerations in relation to visual impairment and morbidity. Orbit. 2003; 22(2): 121–142.
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