Diagnostic Dilemma of Dural Carotid Cavernous Fistula

Noorlaila Baharuddin, Abd Jalil Nor-Fadzillah, Raja Omar Raja-Norliza, Gan Kok Chan Alice, Embong Zunaina

Abstract


We report a case of dural carotid cavernous fistula (CCF) pose a diagnostic dilemma with initial symptoms of the arteriovenous shunt. A 56 year-old man presented with right eye diplopia, then subsequently developed ptosis, congestion of conjunctiva, dilated episcleral vessels, and gradual rise in intraocular pressure. Initial diagnosis of pseudotumour was made based on negative finding of CCF by computed tomography angiography (CTA). In view of persistent clinical manifestations in spite of steroid therapy, and with the presence of new ocular signs; cock-screw conjunctival vessels, dilated retinal veins, and proptosis, digital subtraction angiography (DSA) was performed and confirmed the diagnosis of dural CCF. The ocular symptoms resolved completely post embolization of the fistula.

Keywords


Carotid cavernous fistula, cock-screw vessels, diplopia, proptosis

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References


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