title: Absence of orbito-ocular signs in dural carotid-cavernous sinus fistula with a prominent anterior venous drainage.
abstract: A 55-year-old woman developed an intractable right orbitofrontal headache. The symptoms subsided spontaneously 2 months after onset, but diplopia due to right abducens nerve palsy had occurred, and gradually worsened. Orbito-ocular signs were never observed throughout the clinical course. Brain MRI and MR angiography demonstrated abnormal signal changes corresponding to the right cavernous sinus. Angiography confirmed a dural carotid-cavernous sinus fistula (CCF) with three directional drainage routes in the arterial phase. Although the most prominent draining vein was the superior ophthalmic vein (SOV), an outflow with a high flow rate into the angular facial vein prevented prolonged enhancement of the SOV in the venous phase. These findings suggest that the absence of orbito-ocular signs in dural CCF with an anterior venous drainage could be attributed to the relief of venous hypertension of the SOV.
authors: Third Department of Internal Medicine, Kagawa University School of Medicine, 1750-1 Ikenobe, Miki-cho, Kita-gun, Kagawa 761-0793, Japan.
authors: Kazuyo
authors: K
authors: Ikeda
authors: Kazushi
authors: K
authors: Deguchi
authors: Masago
authors: M
authors: Tsukaguchi
authors: Iwao
authors: I
authors: Sasaki
authors: Mieko
authors: M
authors: Shimamura
authors: Yoshiteru
authors: Y
authors: Urai
authors: Tetsuo
authors: T
authors: Touge
authors: Masahiko
authors: M
authors: Kawanishi
authors: Hiroaki
authors: H
authors: Takeuchi
authors: Shigeki
authors: S
authors: Kuriyama
mesh_terms: D000792:Angiography; D020216:Carotid-Cavernous Sinus Fistula / Q000150:complications / Q000628:therapy*; D004322:Drainage; D005260:Female; D006261:Headache / Q000209:etiology; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods; D008875:Middle Aged; D009915:Orbit / Q000503:physiopathology*; D014680:Veins / Q000033:anatomy & histology / Q000601:surgery*