An arteriovenous malformation masquerading as a carotid-cavernous sinus fistula.
OBJECTIVE
To describe a case of an occipital arteriovenous malformation (AVM) presenting with unilateral signs mimicking a carotid-cavernous sinus fistula (CCF).


METHODS
Interventional case report.


METHODS
A 67-year-old normotensive male presented with loss of vision, pain, and proptosis of the right eye. Best-corrected visual acuity was right eye 6/36 and left eye 6/5. Examination of the right eye revealed orbital congestion with arteriolization of the episcleral vessels and an intra-ocular pressure of 44 mm Hg which was refractory to medical treatment.


RESULTS
Computed tomography (CT) angiogram and cerebral angiography found an occipital AVM draining into the right sphenoparietal sinus and thereafter the right ophthalmic vein, bypassing the cavernous sinus. Embolization followed by excision of the AVM resulted in recovery of vision, reversal of proptosis, and normalization of intraocular pressure.


CONCLUSIONS
Rapid diagnosis and immediate intervention resulted in a rewarding visual recovery despite a persisting left homonymous hemianopia.
Gregory
Maria E
ME
Department of Ophthalmology, University Hospital of Staffordshire, 17 Steel Street, Hartshill, Stoke on Trent, N. Staffordshire ST4 7NS, United Kingdom. rgregory@tesco.net
Berry-Brincat
Antonella
A
Ghosh
Yajati K
YK
Syed
Reshma N
RN
Diaz
Palitha L
PL
Jordan
Timothy L
TL
D000368:Aged; D001165:Arteriovenous Malformations / Q000175:diagnosis* / Q000628:therapy; D020216:Carotid-Cavernous Sinus Fistula / Q000175:diagnosis* / Q000628:therapy; D002426:Cavernous Sinus; D002533:Cerebral Angiography; D003937:Diagnosis, Differential; D004621:Embolization, Therapeutic; D005123:Eye / Q000098:blood supply; D006801:Humans; D007429:Intraocular Pressure; D008297:Male; D014057:Tomography, X-Ray Computed; D014680:Veins / Q000002:abnormalities