Reversal of blindness after transvenous embolization of a carotid-cavernous fistula: case report.
OBJECTIVE
Reversal of blindness after the endovascular treatment of a carotid-cavernous fistula (CCF) is exceedingly rare. It has been reported only once in a patient with a direct CCF. We report the first such case in a patient with an indirect CCF. Defining patients whose vision may recover is critical in coordinating the timing of therapy. Mechanisms of reversible visual loss in CCFs are discussed with the intent of elucidating the patients who compose this subgroup.


METHODS
A 65-year-old man had a 1-week history of blindness, chemosis, and proptosis of the right eye. Ophthalmoscopy was compromised by diffuse choroidal effusion and corneal edema that obscured visualization of the patient's retina.


METHODS
Transvenous embolization through retrograde catheterization of the superior ophthalmic vein allowed complete coil occlusion of the lesion. The patient's visual loss improved rapidly, returning to normal within 50 days.


CONCLUSIONS
Although CCFs frequently are associated with permanent visual loss, a subset of patients demonstrates reversible ocular findings. If the retina of a patient with a CCF seems normal or is obscured, the potential for visual recovery, even from blindness, should prompt emergent treatment.
Albuquerque
Felipe C
FC
Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona 85013, USA. neuropub@chw.edu
Heinz
Grant W
GW
McDougall
Cameron G
CG
D000368:Aged; D001766:Blindness / Q000209:etiology / Q000628:therapy*; D020216:Carotid-Cavernous Sinus Fistula / Q000150:complications / Q000628:therapy*; D015862:Choroid Diseases / Q000209:etiology / Q000628:therapy; D015715:Corneal Edema / Q000209:etiology / Q000628:therapy; D004621:Embolization, Therapeutic; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D011183:Postoperative Complications / Q000209:etiology