title: Direct carotid-cavernous fistula causing brainstem venous congestion.
abstract: A 39-year-old man who presented with unilateral proptosis and periocular pain rapidly developed reduced consciousness, facial numbness, dysarthria, and gait ataxia from a direct carotid-cavernous fistula (CCF) with drainage into posterior fossa veins. Brain MRI revealed abnormal signal throughout the brainstem, indicative of venous hypertension and edema. Closure of the fistula by detachable balloon eliminated the clinical and imaging abnormalities. This is the fifth reported case of brainstem complications of a direct CCF. It highlights potentially serious complications of this condition and their reversibility with prompt treatment.
authors.affiliation: Division of Neuroradiology, Department of Diagnostic Radiology and Nuclear Medicine, London Health Sciences Centre, London, Ontario, Canada. miguel.bussiere@toh.on.ca
authors.forename: Miguel
authors.initials: M
authors.lastname: Bussière
authors.forename: Stephen P
authors.initials: SP
authors.lastname: Lownie
authors.forename: David M
authors.initials: DM
authors.lastname: Pelz
authors.forename: David
authors.initials: D
authors.lastname: Nicolle
mesh_terms: D000328:Adult; D000792:Angiography; D001933:Brain Stem / Q000098:blood supply*; D020216:Carotid-Cavernous Sinus Fistula / Q000150:complications* / Q000175:diagnosis / Q000628:therapy; D002404:Catheterization; D002560:Cerebrovascular Circulation; D006801:Humans; D006940:Hyperemia / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D008279:Magnetic Resonance Imaging; D008297:Male; D009916:Orbital Diseases / Q000175:diagnosis / Q000209:etiology / Q000628:therapy