A case of posterior ischemic optic neuropathy in a posterior-draining dural cavernous sinus fistula.
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.
Hashimoto
Masato
M
Department of Ophthalmology, Sapporo Medical University, Japan. mashoyu5@beige.plala.or.jp
Ohtsuka
Kenji
K
Suzuki
Yasuo
Y
Hoyt
William F
WF
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