Fístula carótido-cavernosa espontánea bilateral: reporte de caso y revisión de la literatura

Abstract

Carotid cavernous fistulas are abnormal connections between the internal or external carotid artery or any branches and the cavernous sinus. They are characterised by proptosis, chemosis and orbital bruits. The carotid cavernous fistulas have a low incidence, especially if they are spontaneous and bilateral. They are associated with high morbidity, and require high clinical suspicion, early diagnosis, and specific treatment. They require emergency management when presented with signs of poor prognosis, such as rapidly progressive proptosis, intra-cerebral haemorrhage, or massive epistaxisThe case is presented of a 56 year-old patient with a history of bilateral glaucoma, high blood pressure (arterial hypertension), and chronic headache. She consulted due to changes in the pattern of headache, with signs of red flag due to the rapidly progressive severe pain, loss of consciousness and subsequent amnesia of the event. The cranial computed tomography scan showed asymmetry of the cavernous sinus and a hyperdense area to the right side. The magnetic resonance showed loss of cleavage in the segment of the cavernous portion of the right internal carotid artery, a finding suggestive of recent bleeding aneurysm. A cerebral angiography was performed, and a Barrow type D bilateral carotid cavernous fistula was diagnosed. Endovascular therapy was performed, with successful obliteration of both carotid cavernous fistulas.The literature review is presented along with evidence about the treatment of this disease.