Journal
CLINICAL NEUROLOGY AND NEUROSURGERY
Volume 108, Issue 6, Pages 576-579Publisher
ELSEVIER SCIENCE BV
DOI: 10.1016/j.clineuro.2005.03.010
Keywords
carotid-cavernous fistula; head trauma; visual evoked potentials; embolisation; perfusion pressure breakthrough
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A 68-year-old woman developed right pulsatile exophtalmos in the early course of facial and head trauma. Investigations by visual evoked potentials suggested the presence of a bilateral prechiasmatic lesion. Intraocular pressure rapidly increased and a high-flow carotid-cavernous fistula was evident at carotid angiography. Immediately after the treatment of the right fistula by balloon embolisation, a systolic bruit was noted over the left eyeball and angiography disclosed the presence of a left carotid-cavernous fistula that was treated by the same approach. The patient developed brain oedema leading to death and we postulated that reestablishment of normal cerebral perfusion after abrupt closure of the fistulas may have played a deleterious role. (c) 2005 Elsevier B.V. All rights reserved.
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