Posters

The post-traumatic carotid-cavernous fistula: just think about it!

Poster Details

First Author: I.Messafi MOROCCO

Co Author(s): H. Boutahar   A. Mekkaoui   S. Chariba   A. Maadane   R. Sekhsoukh        

Abstract Details

Purpose:

The carotid-cavernous fistula is a major ophthalmological and vital emergency. the diagnosis being most often clinical, some more insidious cases constitute a real challenge. The absence of quick management based on embolization, can threaten the functional and vital prognosis.

Setting:

Mohammed VI University hospital , Oujda, Morocco

Methods:

We report two cases of post-traumatic carotid-cavernous fistula with different presentations.

Results:

case1: 31-years-old  patient with history of cranial trauma, admitted for red left eye, decreasing visual acuity( VA). VA: hand movement, exophthalmia, limited abduction, hyperemia,“Medusa head", mydriasis, cup/disc ratio =0.7, retinal vessels dilatation, thrill and murmur.CT scan: Left cavernous sinus(CS) and ophthalmic vein ectasia. Embolization was considered. Case2: 72-years-old patient, history of craniofacial trauma, admitted for eyes pain and redness and reduced VA .Examination: bilateral hyperemia, right chemosis (rapidly worsening), exophthalmia, keratopathy, "Medusa head“ and hyphaema. CT scan: bilateral CS and ophthalmic veins ectasia.  Right CS embolization and tarsoraphy were performed.Symptomatology switches to left. Contralateral embolization is considered.

Conclusions:

Carotid-cavernous fistula is a rare but blinding or fatal condition, defined as pathological communication between the internal carotid artery and cavernous sinus. Its main etiology remains trauma and neurosurgical procedures.the clinical presentation is polymorphic and the signs are essentially ophthalmic, ranging as we see from hypermia to papilledema. The confirmation of diagnosis is based on radiological exploration, especially arteriography which is the first step of embolization.The surgery is reserved for the cases with a failure of emobilzation. The interest of these two cases lies in the atypical character of their presentation (bilateral  switching character, hyphema, absence or presence of murmur...).

Financial Disclosure:

None