title: Brainstem hemorrhage caused by direct carotid-cavernous fistula. A case report and literature review.
abstract: A 34-year-old woman presented with a history of persisting headache for years, and a newly developed dizziness, left facial palsy and right hemiparesis two days prior to this admission. Initial computed tomographic angiography of the head demonstrated an area of increased density in the left middle and posterior fossae. Multiple aneurysmally dilated venous ectasias with contrast enhancement at the left pre-pontine cistern causing a massive mass effect to the brainstem were also noted, suggesting a huge vascular abnormality. Digital subtraction angiography revealed an abnormal vascular lesion surrounding the brainstem, which indicated a left direct carotid-cavernous fistula with posterior drainage. As her consciousness deteriorated the next day, a follow-up computed tomography scan was done which revealed a pontine hemorrhage. Subsequently, endovascular closure of the fistula with sacrifice of the left ICA was performed, which successfully eliminated the imaging abnormalities.
authors.affiliation: Department of Neurosurgery, School of Medicine, Chung Shan Medical University Hospital; Taichung, Taiwan - fhchantw@gmail.com.
authors.forename: Fook-How
authors.initials: FH
authors.lastname: Chan
authors.affiliation: Department of Medical Imaging, School of Medical Imaging and Radiological Sciences, - School of Medicine, Chung Shan Medical University Hospital; Taichung, Taiwan.
authors.forename: Chao-Yu
authors.initials: CY
authors.lastname: Shen
authors.affiliation: Department of Neurosurgery, School of Medicine, Chung Shan Medical University Hospital; Taichung, Taiwan.
authors.forename: Jung-Tung
authors.initials: JT
authors.lastname: Liu
authors.affiliation: Department of Neurosurgery, School of Medicine, Chung Shan Medical University Hospital; Taichung, Taiwan.
authors.forename: Cho-Shun
authors.initials: CS
authors.lastname: Li
mesh_terms: D000328:Adult; D015901:Angiography, Digital Subtraction; D001933:Brain Stem / Q000098:blood supply* / Q000000981:diagnostic imaging; D020216:Carotid-Cavernous Sinus Fistula / Q000150:complications* / Q000000981:diagnostic imaging / Q000601:surgery*; D002543:Cerebral Hemorrhage / Q000000981:diagnostic imaging / Q000209:etiology* / Q000601:surgery*; D057510:Endovascular Procedures / Q000379:methods*; D005260:Female; D006801:Humans
keywords: brainstem hemorrhage; carotid-cavernous fistula; venous pouch