Bilateral carotid-cavernous fistula following head trauma: Possible worsening of brain injury following balloon catheter occlusion?
A 68-year-old woman developed right pulsatile exophtalmos in the early course of facial and head trauma. Investigations by visual evoked potentials suggested the presence of a bilateral prechiasmatic lesion. Intraocular pressure rapidly increased and a high-flow carotid-cavernous fistula was evident at carotid angiography. Immediately after the treatment of the right fistula by balloon embolisation, a systolic bruit was noted over the left eyeball and angiography disclosed the presence of a left carotid-cavernous fistula that was treated by the same approach. The patient developed brain oedema leading to death and we postulated that reestablishment of normal cerebral perfusion after abrupt closure of the fistulas may have played a deleterious role.
Hantson
Philippe
P
Department of Intensive Care, Cliniques St-Luc, Université catholique de Louvain, Avenue Hippocrate, 10, 1200 Brussels, Belgium. hantson@rean.ucl.ac.be
Espeel
Benoît
B
Guérit
Jean-Michel
JM
Goffette
Pierre
P
D000368:Aged; D021721:Balloon Occlusion / Q000009:adverse effects*; D020216:Carotid-Cavernous Sinus Fistula / Q000000981:diagnostic imaging / Q000209:etiology* / Q000628:therapy; D006259:Craniocerebral Trauma / Q000150:complications*; D017809:Fatal Outcome; D005260:Female; D006801:Humans; D011859:Radiography