Редкий случай развития каротидно-кавернозного соустья в офтальмологической практике

Abstract

Purpose. Demonstration of a clinical case of the formation of carotid-cavernous fistula (CCF), which we observed in our ophthalmological practice. Material and methods. A 52-year-old patient who was urgently referred for surgical treatment of orbital phlegmon, accompanied by a decrease in vision to 0.02, reactive eyelid edema, secondary glaucoma, and rather mild exophthalmos of the left eye. On the same day, she was admitted to the hospital, where she underwent an opening and drainage of the orbit. However, after 5 days, against the background of further anti-inflammatory therapy, the patient began to be disturbed by a noise in the head, reminiscent of the «noise of a steam locomotive», and pain in the left eye appeared. Conducted selective computed tomography with angiography made it possible to establish the final diagnosis: cerebrovascular disease, arteriovenous malformation in the projection of the supraclinoid section of the left internal carotid artery, post-traumatic CCF on the left side. First, the patient underwent a course of vascular, decongestant, and symptomatic therapy, and then endovascular embolization CCF of the left side was successfully performed. Results. After that, headaches and noise in the head disappeared, exophthalmos and congestion in the form of edema of the eyelids and bulbar conjunctiva gradually regressed. However, the visual acuity of the left eye remained reduced (0.03) due to atrophy of the optic nerve. Conclusion. The rare occurrence of this pathology in ophthalmic practice may cause the lack of alertness of doctors of this specialty in terms of timely diagnosis of CCF. At the same time, it should be taken into account that neuroophthalmic symptoms are of decisive importance in clarifying the indications for the accelerated conduct of the only effective surgical endovascular treatment of this pathology. Particular care should be taken in cases where the patient has unilateral exophthalmos with a pulsating noise in the head and a history of blunt head trauma from several days to 2 months before their onset. Keywords: traumatic brain injury, carotid-cavernous fistula, diagnosis, carotid angiography, endovascular surgical treatment