Bilateral Low-Flow Type-D Dural Carotid-Cavernous Fistula : Diagnosis and Treatment with 3D Time-of-Flight Magnetic Resonance Angiography

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dc.contributor.authorBalodis, Arturs
dc.contributor.authorKalējs, Verners Roberts
dc.contributor.authorMigunova, Kristīne
dc.contributor.institutionDepartment of Radiology
dc.date.accessioned2024-04-09T12:15:02Z
dc.date.available2024-04-09T12:15:02Z
dc.date.issued2024
dc.descriptionPublisher Copyright: © Am J Case Rep, 2024.
dc.description.abstractPatient: Female, 62-year-old Final Diagnosis: Bilateral dural carotid cavernous fistula Symptoms: Bilateral periorbital edema • conjunctival chemosis • diminished visual acuity • diplopia • ophthalmoplegia Clinical Procedure: Endovascular coil embolisation Specialty: Ophthalmology • Radiology Objective: Rare disease Background: Carotid-cavernous fistula (CCF) is a rare, atypical vascular shunt between the carotid arterial system and the venous channels of the cavernous sinus, classified according to the shunt’s anatomy, by etiology (resulting from trauma or occurring spontaneously), or by hemodynamic characteristics (such as low-or high-flow fistulas). Case Report: A 62-year-old female patient with poorly controlled arterial hypertension presented with bilateral periorbital edema, conjunctival chemosis, ophthalmoplegia, diplopia, and diminished visual acuity. On magnetic resonance angiography (MRA), abnormal arterial flow along the cavernous sinuses was noted, suggestive of bilateral CCF. The diagnosis of indirect dural low-flow CCF (Barrow Type D) was later confirmed by digital subtraction angiography, with feeding arteries from intracavernous internal carotid artery branches, and meningeal branches of the external carotid artery, draining bilaterally to ophthalmic veins, the intracavernous sinus, and the inferior petrosal sinus. The patient was successfully treated with endovascular embolization. At 7-month follow-up, no residual arteriovenous shunting was detected. This case highlights the importance of non-invasive radiological methods for CCF, and presents rarely published radiological findings of bilateral Type-D dural CCFs on 3-dimensional time-of-flight MRA with post-treatment MRA follow-up. Conclusions: Regardless of the patient’s history of possible trauma, a patient presenting with bilateral periorbital edema, conjunctival chemosis, ophthalmoplegia, diplopia, and diminished visual acuity should have a spontaneous bilateral CCF investigated to prevent delayed treatment. Experienced neuroradiologists are needed to accurately detect indirect CCF, since this condition often does not demonstrate classic symptoms.en
dc.description.statusPeer reviewed
dc.format.extent1290098
dc.identifier.citationBalodis, A, Kalējs, V R & Migunova, K 2024, 'Bilateral Low-Flow Type-D Dural Carotid-Cavernous Fistula : Diagnosis and Treatment with 3D Time-of-Flight Magnetic Resonance Angiography', American Journal of Case Reports, vol. 25, e942833. https://doi.org/10.12659/AJCR.942833
dc.identifier.doi10.12659/AJCR.942833
dc.identifier.issn1941-5923
dc.identifier.urihttps://dspace.rsu.lv/jspui/handle/123456789/15422
dc.identifier.urlhttp://www.scopus.com/inward/record.url?scp=85188046005&partnerID=8YFLogxK
dc.language.isoeng
dc.relation.ispartofAmerican Journal of Case Reports
dc.rightsinfo:eu-repo/semantics/openAccess
dc.subjectCarotid-Cavernous Sinus Fistula
dc.subjectCavernous Sinus
dc.subjectMagnetic Resonance Angiography
dc.subjectMagnetic Resonance Imaging
dc.subjectRadiology, Interventional
dc.subject3.2 Clinical medicine
dc.subject1.1. Scientific article indexed in Web of Science and/or Scopus database
dc.subjectGeneral Medicine
dc.titleBilateral Low-Flow Type-D Dural Carotid-Cavernous Fistula : Diagnosis and Treatment with 3D Time-of-Flight Magnetic Resonance Angiographyen
dc.type/dk/atira/pure/researchoutput/researchoutputtypes/contributiontojournal/article

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