Absence of orbito-ocular signs in dural carotid-cavernous sinus fistula with a prominent anterior venous drainage.
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.
Ikeda
Kazuyo
K
Third Department of Internal Medicine, Kagawa University School of Medicine, 1750-1 Ikenobe, Miki-cho, Kita-gun, Kagawa 761-0793, Japan.
Deguchi
Kazushi
K
Tsukaguchi
Masago
M
Sasaki
Iwao
I
Shimamura
Mieko
M
Urai
Yoshiteru
Y
Touge
Tetsuo
T
Kawanishi
Masahiko
M
Takeuchi
Hiroaki
H
Kuriyama
Shigeki
S
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*