Arteriovenous Malformation in Temporal Lobe Presenting as Contralateral Ocular Symptoms Mimicking Carotid-Cavernous Fistula

Fadzillah Mohd-Tahir,Ishak Siti-Raihan,W H Wan Hazabbah

doi:10.1155/2013/158961

Fadzillah Mohd-Tahir, Ishak Siti-Raihan + Show 1 more

Open Access

https://doi.org/10.1155/2013/158961

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Abstract

Aim. To report a rare case of arteriovenous malformation in temporal lobe presenting as contralateral orbital symptoms mimicking carotid-cavernous fistula. Method. Interventional case report. Results. A 31-year-old Malay gentleman presented with 2-month history of painful progressive exophthalmos of his left eye associated with recurrent headache, diplopia, and reduced vision. Ocular examination revealed congestive nonpulsating 7 mm exophthalmos of the left eye with no restriction of movements in all direction. There was diplopia in left lateral gaze. Left IOP was elevated at 29 mmHg. Left eye retinal vessels were slightly dilated and tortuous. CT scan was performed and showed right temporal arteriovenous malformation with a nidus of 3.8 cm × 2.5 cm with right middle cerebral artery as feeding artery. There was dilated left superior ophthalmic vein of 0.9 mm in diameter with enlarged left cavernous sinus. MRA and carotid angiogram confirmed right temporal arteriovenous malformation with no carotid-cavernous fistula. Most of the intracranial drainage was via left cavernous sinus. His signs and symptoms dramatically improved following successful embolisation, completely resolved after one year. Conclusion. Intracranial arteriovenous malformation is rarely presented with primary ocular presentation. Early intervention would salvage the eyes and prevent patients from more disaster morbidity or fatality commonly due to intracranial haemorrhage.

Highlights

Intracranial arteriovenous malformations (AVMs) are cerebrovascular lesions which consist of networks of arterial and venous channels which communicate directly without any intervening capillary bed
Acquired carotid-cavernous sinus fistula is the most common types of AVM encountered by Ophthalmologist [1]
Patients presented with ocular symptoms resulted from abnormal communication between arterial and venous channels within the cavernous sinus

Summary

Introduction

Intracranial arteriovenous malformations (AVMs) are cerebrovascular lesions which consist of networks of arterial and venous channels which communicate directly without any intervening capillary bed. These abnormal communications are divided into two types, plexiform and fistulous. The fistulous types are known as dural AVMs, which are supplied by meningeal branches of external carotid artery. The plexiform type is supplied by branches of the cerebral or cerebellar arteries and known as pial AVMs. Acquired carotid-cavernous sinus fistula is the most common types of AVM encountered by Ophthalmologist [1]. Patients presented with ocular symptoms resulted from abnormal communication between arterial and venous channels within the cavernous sinus. Ocular symptoms rarely become primary manifestation of intracranial AVMs [2]

Case Report

Discussion

Conclusion