Delayed Onset Central Retinal Vein Occlusion (CRVO) in Traumatic Carotid Cavernous Sinus Fistula (CCSF)-A Case Report

Abstract

Purpose: To report a patient suffering from untreated traumatic carotid cavernous sinus fistula (CCSF), followed by delayed onset central retinal vein occlusion (CRVO) and presentation on color fundus images, computer tomography angiography (CTA) and cerebral angiography, optical coherence tomography (OCT). Method: Case report. Result: We present the case of a patient who suffered from a blunt head injury resulting in a delayed diagnosis of a carotid-cavernous sinus fistula and subsequent central retinal vein occlusion (CRVO). A 56-year-old male patient presented as progressively blurred vision of the left eye and diplopia for about 2 months after falling from a tree 6 months ago. The symptom of persistent bruit and mild left orbital distention was noted 1-2 days after trauma, but subsided later. Unable to tolerate blurred vision and bruit disturbance that had persisted for several months, the patient sought medical help. Left eyeball protrusion with bulbar conjunctival vessels engorged, lateral gaze limitation of the left eye, and extensive retinal hemorrhages and dilated tortuous veins with cotton wool spots in fundus, and best corrected visual acuity 20/70 were noted. There is no elevated intraocular pressure and absence of relative afferent pupillary defect. Enlarged left superior ophthalmic vein and left cavernous sinus were identified on both CTA and conventional cerebral angiography that is compatible with direct carotid cavernous fistula. OCT revealed mild macular edema (237um). An endovascular embolization was advised, but the patient asked to be discharged due to more time needed for considering the insurance coverage and arranging for claims. Conclusion: Patient with CRVO induced by traumatic CCSF seems to have better visual acuity outcome in this case report. Early medical consultation or CCSF detection may prevent subsequent complications including CRVO and visual deterioration.