title: A case of posterior ischemic optic neuropathy in a posterior-draining dural cavernous sinus fistula.
abstract: A 79-year-old woman presented with sudden unilateral visual loss after an ocular motor disturbance and pulsatile tinnitus. Neuro-ophthalmologic examination showed a presumed right posterior ischemic optic neuropathy (PION), oculosympathetic, and third, sensory fifth, and sixth cranial nerve pareses. Selective angiography of the right internal and external carotid arteries confirmed a posterior-draining dural carotid cavernous sinus fistula (CCF) fed by the right meningohypophyseal trunk and right middle meningeal artery. Angiography also showed an ophthalmic-middle meningeal arterial anastomosis. We postulate that the PION was caused by an arterial steal, because blood was drawn into the fistula and away from the intraorbital optic nerve.
authors.affiliation: Department of Ophthalmology, Sapporo Medical University, Japan. mashoyu5@beige.plala.or.jp
authors.forename: Masato
authors.initials: M
authors.lastname: Hashimoto
authors.forename: Kenji
authors.initials: K
authors.lastname: Ohtsuka
authors.forename: Yasuo
authors.initials: Y
authors.lastname: Suzuki
authors.forename: William F
authors.initials: WF
authors.lastname: Hoyt
mesh_terms: D000368:Aged; D001766:Blindness / Q000209:etiology; D002342:Carotid Artery, External / Q000002:abnormalities / Q000000981:diagnostic imaging; D002343:Carotid Artery, Internal / Q000002:abnormalities / Q000000981:diagnostic imaging; D020216:Carotid-Cavernous Sinus Fistula / Q000150:complications* / Q000175:diagnosis / Q000628:therapy; D020785:Central Nervous System Vascular Malformations / Q000150:complications* / Q000175:diagnosis / Q000628:therapy; D002533:Cerebral Angiography; D003389:Cranial Nerve Diseases / Q000209:etiology; D004621:Embolization, Therapeutic; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D018917:Optic Neuropathy, Ischemic / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy