Spontaneous resolution of two dural carotid-cavernous fistulas presenting with optic neuropathy and marked congestive ophthalmopathy.
Two patients with dural carotid-cavernous fistulas (CCFs) presented with optic neuropathy and marked congestive ophthalmopathy, including 1 patient with a narrowed anterior chamber angle due to choroidal effusions. Endovascular intervention was planned but deferred for logistic reasons. While the patients awaited the procedures, the clinical features markedly improved, and time-resolved imaging of contrast kinetics (TRICKS) MRA was consistent with closure of the CCFs. These patients serve as a reminder that spontaneous resolution may occur in dural CCFs even when presenting clinical features are florid and vision appears to be threatened. In fact, a rapid worsening of clinical manifestations may be a sign that a dural CCF is about to close spontaneously.
Bujak
Mathew
M
Department of Ophthalmology and Visual Sciences, University of Toronto, Toronto, Ontario, Canada. edmargolin@gmail.com
Margolin
Edward
E
Thompson
Andrew
A
Trobe
Jonathan D
JD
D000368:Aged; D020216:Carotid-Cavernous Sinus Fistula / Q000150:complications* / Q000175:diagnosis / Q000601:surgery; D002533:Cerebral Angiography / Q000379:methods; D057510:Endovascular Procedures / Q000379:methods; D005260:Female; D049970:Graves Ophthalmopathy / Q000150:complications* / Q000175:diagnosis; D006801:Humans; D018810:Magnetic Resonance Angiography / Q000379:methods; D033401:Microscopy, Acoustic / Q000379:methods; D009901:Optic Nerve Diseases / Q000150:complications* / Q000175:diagnosis; D014057:Tomography, X-Ray Computed / Q000379:methods