Hemiparesis in carotid cavernous fistulas (CCFs): a case report and review of the literature.
Carotid-cavernous fistulas (CCFs) are abnormal arteriovenous anastamoses between the carotid artery and the cavernous sinus. These fistulas may be classified by cause (spontaneous or traumatic), flow velocity (high or low), or pathogenesis (direct or indirect). The most commonly adopted classification is that described by Barrow based on arterial supply. Traumatic CCFs are almost always direct shunts between the internal carotid artery (ICA) and the cavernous sinus. General features of CCFs, which may be apparent with any lesion, including bruit, headache, loss of vision, altered mental status and neurological deficits. Some fistulae may present primarily with hemorrhage before any evaluation can be performed. However, hemiparesis has been rarely observed. Only a literature review of Murata et al reported a case of hemiparesis caused by posttraumatic CCF, in which the fistula resulted in venous hypertension and subsequent brainstem congestion. While in our case, cerebral infarction was caused by total steal of the blood flow. The patient recovered after occlusion of the fistula with a detachable balloon.
Wang
Hui-Xiao
HX
Department of Neurosurgery, Changzheng Hospital, Shanghai 200021, China. wwxnj@sohu.com
Bai
Ru-Lin
RL
Huang
Cheng-Guang
CG
Lu
Yi-Cheng
YC
Zhang
Guang-Ji
GJ
D000328:Adult; D021721:Balloon Occlusion / Q000379:methods*; D020216:Carotid-Cavernous Sinus Fistula / Q000150:complications / Q000000981:diagnostic imaging* / Q000628:therapy*; D002533:Cerebral Angiography; D006259:Craniocerebral Trauma / Q000150:complications / Q000175:diagnosis; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D010291:Paresis / Q000150:complications / Q000175:diagnosis*; D020127:Recovery of Function; D018570:Risk Assessment; D012720:Severity of Illness Index; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014949:Wounds, Nonpenetrating / Q000150:complications