title: Spontaneous subarachnoid hemorrhage as the primary manifestation of carotid cavernous fistulas: case report.
abstract: We report the case of a 19-year old male patient initially admitted to our service after a motor vehicle accident with a normal neurologic evaluation and a CT scan that revealed no abnormalities. Nineteen months later, he was readmitted after a subtle headache episode, followed by a brief loss of consciousness. He was submitted to a complete evaluation, which revealed no abnormalities (even in the neurologic and ophthalmologic exams). A CT was performed revealing a diffuse subarachnoid hemorrhage. Contrast enhancement displayed a right paraselar lesion, which was first interpreted as a giant aneurysm. The patient underwent a cerebral angiography which showed a right carotid-cavernous fistula with retrograde venous drainage through the superior and inferior petrosal sinuses. Filling of various cortical vessels was observed. The patient was treated with endovascular technique and a control angiographic study assured the complete closure of the fistula. He had an excellent clinical recovery, being discharged in good conditions.
authors.affiliation: Division of Neurosurgery, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil. chamani@ig.com.br
authors.forename: C
authors.initials: C
authors.lastname: Hamani
authors.forename: A F
authors.initials: AF
authors.lastname: Andrade
authors.forename: E G
authors.initials: EG
authors.lastname: Figueiredo
authors.forename: O
authors.initials: O
authors.lastname: Ciquini
authors.forename: R
authors.initials: R
authors.lastname: Marino
mesh_terms: D000328:Adult; D020216:Carotid-Cavernous Sinus Fistula / Q000150:complications* / Q000000981:diagnostic imaging / Q000628:therapy; D006801:Humans; D008297:Male; D011859:Radiography; D013345:Subarachnoid Hemorrhage / Q000000981:diagnostic imaging / Q000209:etiology* / Q000628:therapy