title: [Case of direct carotid-cavernous fistula presenting with subarachnoid hemorrhage].
abstract: We report a case of longstanding asymptomatic direct carotid-cavernous fistula (CCF) which caused fatal subarachnoid hemorrhage (SAH). A 91-year-old female with no history of previous head trauma and optic symptoms presented acute subarachnoid hemorrhage. Angiography revealed a left direct carotid-cavernous fistula draining only into the contralateral cavernous sinus with leptomeningeal venous reflux and small varix on the pontine bridging vein. The affected cavernous sinus was markedly dilated and there was no septum between the left cavernous sinus and the internal carotid artery. The patient underwent transvenous coil embolization for intercavernous sinus and leptomeningeal venous reflux was successfully obliterated and opacification of the varix was diminished. The past history of this patient and angiographical findings strongly suggest long standing asymptomatic CCF caused SAH.
authors.affiliation: Department of Neurosurgery, Hokkaido University Graduate School of Medicine.
authors.forename: Takeshi
authors.initials: T
authors.lastname: Asano
authors.forename: Kiyohiro
authors.initials: K
authors.lastname: Houkin
authors.forename: Takuya
authors.initials: T
authors.lastname: Moriwaki
authors.forename: Yoshimasa
authors.initials: Y
authors.lastname: Niiya
authors.forename: Shyouji
authors.initials: S
authors.lastname: Mabuchi
mesh_terms: D000369:Aged, 80 and over; D015901:Angiography, Digital Subtraction; D020216:Carotid-Cavernous Sinus Fistula / Q000150:complications* / Q000000981:diagnostic imaging / Q000628:therapy; D004621:Embolization, Therapeutic; D017809:Fatal Outcome; D005260:Female; D006801:Humans; D013345:Subarachnoid Hemorrhage / Q000209:etiology*; D014057:Tomography, X-Ray Computed