Hemispheric laminar necrosis as a complication of traumatic carotid-cavernous sinus fistula.
A 43-year-old woman presented with a very rare case of hemispheric laminar necrosis as a complication of traumatic carotid-cavernous sinus fistula (CCF). The patient suffered head injury and extensive burns following a car accident. Oral intubation was performed under sedation. When sedation was discontinued 17 days after injury, the patient demonstrated left hemiparesis. Magnetic resonance imaging showed laminar necrosis affecting the right cerebral hemisphere. Angiography revealed a right high-flow direct CCF. Transarterial embolization of the fistula using a detachable balloon achieved complete occlusion of the fistula. However, the left hemiparesis persisted following this intervention. Traumatic CCF may be missed in patients with disturbed consciousness, so clinicians should not overlook possibility of the triad of symptoms of CCF in patients with head injury.
Kato
Masayasu
M
Advanced Critical Care Center, Gifu University Hospital, Gifu, Japan. masayasu.kato@nifty.ne.jp
Ikegame
Yuka
Y
Toyoda
Izumi
I
Ogura
Shinji
S
Kitajima
Hideomi
H
Yoshimura
Shinichi
S
Iwama
Toru
T
D000063:Accidents, Traffic; D000328:Adult; D001164:Arteriovenous Fistula / Q000150:complications* / Q000000981:diagnostic imaging / Q000601:surgery; D002545:Brain Ischemia / Q000175:diagnosis / Q000209:etiology* / Q000473:pathology; D002056:Burns / Q000150:complications; D020212:Carotid Artery Injuries / Q000150:complications* / Q000000981:diagnostic imaging / Q000601:surgery; D002404:Catheterization; D002426:Cavernous Sinus / Q000000981:diagnostic imaging / Q000293:injuries* / Q000601:surgery; D002533:Cerebral Angiography; D003128:Coma / Q000209:etiology; D003229:Conjunctival Diseases / Q000209:etiology; D006259:Craniocerebral Trauma / Q000150:complications* / Q000601:surgery; D004487:Edema / Q000209:etiology; D004621:Embolization, Therapeutic; D005094:Exophthalmos / Q000209:etiology; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D009336:Necrosis; D010291:Paresis / Q000209:etiology*