Presentation
Fall down numerous stairs. Numerous fractures throughout body. Intubated for airway protection.
Patient Data
There is an irregularity of the left cavernous segment of the internal carotid artery appearing contiguous with the medial margin of the left cavernous sinus, demonstrating asymmetric, robust contrast enhancement. The left superior ophthalmic vein also appears mildly enlarged and hyperenhancing compared to the right side.
There is intraventricular hemorrhage within both lateral ventricles (left greater than right), third, and fourth ventricles, without acute hydrocephalus.
There are fractures involving the lateral orbital wall and the orbital floor of the left orbit. There is an associated left periorbital hematoma. There are also fractures of the left zygomatic arch and walls of the left maxillary sinus which extend through the skull base. There is a partially imaged left mandibular fracture.
This is a lateral view digital subtraction angiography with cannulation of the left common carotid artery. Following injection of contrast into the left common and internal carotid artery, contrast opacified the cerebral venous system, such as the cavernous sinus.
Case Discussion
This is a case of a direct carotid-cavernous fistula (CCF) following a trauma. Neurosurgery performed a digital subtraction angiography (as above), which confirmed the diagnosis. The patient underwent placement of a covered stent in the petrous-cavernous junction as well as coiling of the anterior cavernous sinus.
Co-author:
Morgan Zhao, MD
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