Bilateral carotid cavernous fistula after trauma: a case report and literature review

Jingshan Liang,Xiuli Wei,Xiaoxiao Xie,Aimin Li,Yong Sun

doi:10.1186/s41016-021-00265-x

Abstract

BackgroundCarotid cavernous fistula is a rare complication that is typically associated with head trauma and skull base fractures. The traumatic bilateral carotid cavernous fistula are significantly rarer.Case presentationsWe report a case of a 61-year-old man presenting with unilateral exophthalmos, swollen eyelids, conjunctival congestion, and edema etiologically associated with severe trauma. Thereafter, the patient demonstrated symptoms of contralateral oculomotor nerve injury caused by skull base fracture, such as ptosis of eyelid, dilated pupils, and eye movement disorder, and was diagnosed with bilateral carotid cavernous fistula.ConclusionsThe patient recovered after undergoing endovascular embolization of bilateral cavernous sinus fistulas. The patient demonstrated the classic symptoms of an extremely rare condition known as bilateral carotid cavernous fistula, in only one eye. Reporting and analyzing this case will help us elucidate the underlying mechanisms of this disease.

Highlights

Carotid cavernous fistula is a rare complication that is typically associated with head trauma and skull base fractures
Carotid cavernous fistula (CCF) is an abnormal arteriovenous communication formed between carotid artery and its branches due to the influence of external factors such as trauma, or spontaneous and cavernous sinus, resulting in a series of clinical symptoms and signs associated with the blood stealing and increased venous pressure
We introduced coils to embolize the cavernous sinus and the fistula including both the distal and proximal ends, and the internal carotid artery, following which we performed angiography of the left common carotid and vertebral arteries which showed the occlusion of the left internal carotid artery and the disappearance of the cavernous sinus fistula (Fig. 3B, C)

Summary

Conclusions

Bilateral CCF secondary to craniocerebral injury does not always demonstrate the classic “triple syndrome,” which increases the difficulty of diagnose, and is often missed. Reporting and analyzing this case will help us elucidate the underlying mechanisms of this disease. We recommend that patients with skull base fractures should undergo a routine CTA examination to avoid missed diagnosis, to ensure that patients receive accurate and effective treatment

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