Abstract
We report a case of a 90-year-old patient with intractable posterior epistaxis presenting as the only symptom of a nontraumatic low-flow carotid-cavernous sinus fistula. Purpose of this case report is to introduce low-flow carotid-cavernous sinus fistula in the differential diagnosis of intractable posterior epistaxis. We provide a literature review for the sequence of actions for the confrontation of posterior epistaxis. We also emphasize the significance of the radiological diagnostic and therapeutic procedures in the management of posterior epistaxis due to pathology of the cavernous sinus. The gold-standard diagnostic procedure of carotid-cavernous sinus fistula is digital subtraction angiography (DSA). DSA with coils is also the state-of-the-art therapy. By failure of DSA, neurosurgery or stereotactic radiosurgery (SRS) may be used as alternatives. SRS may also be used as enhancement procedure of the DSA. Considering the prognosis of a successfully closed carotid-cavernous sinus fistula, recanalization occurs only in a minority of patients. Close follow-up is advised.
Highlights
We report a case of a 90-year-old patient with recurrent epistaxis presenting as the only symptom of a nontraumatic low-flow carotid-cavernous sinus fistula
To the best of our knowledge, a case of nontraumatic low-flow carotid-cavernous fistula (CCF) presenting as intractable posterior epistaxis has never been described
Angiography revealed a low-level arteriovenous fistula in the right cavernous sinus, which was supplied from branches of the right internal carotid artery (ICA) and the external carotid artery (ECA)
Summary
We report a case of a 90-year-old patient with recurrent epistaxis presenting as the only symptom of a nontraumatic low-flow carotid-cavernous sinus fistula. To the best of our knowledge, a case of nontraumatic low-flow CCF presenting as intractable posterior epistaxis has never been described. Purpose of this case report is to introduce low-flow carotid-cavernous sinus fistula in the differential diagnosis of intractable posterior epistaxis. We provide a literature review for the sequence of actions for the confrontation of posterior epistaxis. We emphasize the significance of radiological diagnostic and therapeutic procedures in the management of posterior epistaxis due to pathology of the cavernous sinus
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