Early diagnosis of traumatic optic neuropathies combined with internal carotid artery injury

Abstract

Objective To explore the methods of early diagnosis of traumatic optic neuropathies combined with internal carotid artery injury.Methods A retrospective study of 1 081 cases of traumatic optic neuropathy from Apr.2007 to Apr.2012 was performed.The CT angiography and/or magnetic resonance angiography were used as screening tools for the suspicious patients.The mechanisms of injury,clinical manifestations and neuroradiological features of internal carotid artery injury patients were discussed.Results In 1 081 cases of traumatic optic neuropathy,26 cases(2.4％)combined with internal carotid artery injury:12 cases were traumatic pseudoaneurysm,9 traumatic carotid cavernous fistula,4 traumatic pseudoaneurysm combined with carotid cavernous fistula,1 dural arteriovenous fistula.17 cases were treated by endovascular embolization,including detachable balloon technique in 10 cases,microcoils embolization in 7,and Onyx embolization in 1.The internal carotid artery was occluded in 7 cases.One intraorbital traumatic ophthalmic artery aneurysm was resected by cranio-orbital craniotomy.In the untreated team,2 cases died of hemorrhage.Conclusions For patients of traumatic optic neuropathies with unilateral blindness and posttraumatc epistaxis,if CT scan showed traumatic subarachnoid hemorrhage and fracture of the lateral wall of sphenoid sinus,CTA and/or MRA should be performed as the initial screening examination for internal carotid artery injury.As soon as a traumatic pseudoaneurysm was found,endovascular management should be initiated promptly. Key words: Traumatic optic neuropathies ; Traumatic subarachnoid hemorrhage ; Internal carotid artery ; Pseudoaneurysm