Diagnosis with Carotid Cavernous Fistula in Ophthalmologic Practice. Clinical case

Purpose: A clinical case of carotid cavernous fistula in ophthalmologic practice. Methods. Patient M., 68 years old, came to the ophthalmologic department with complaints of decreased vision, redness, swelling of the right eye mucosa, and pain in the right parietal region. From the anamnesis morbi it is known that the above-mentioned complaints have been bothering for the last 3 months. She denies traumas. Аnamnesis vitae: Hypertensive disease for about 10 years, regularly takes hypotensive drugs. The polyclinic at the place of residence diagnosed chronic conjunctivitis of the right eye. The prescribed local treatment was followed, without positive effect. Standard ophthalmologic examination was performed; as a follow-up examination, duplex transcranial scanning of arteries and veins, duplex scanning of brachiocephalic arteries with color Doppler mapping of blood flow, MRI of the brain and orbit, CT angiography of cerebral vessels with contrast enhancement were prescribed. The patient was examined by a neurosurgeon and selective cerebral angiography of the brain with intravenous amplification was prescribed. The final diagnosis was made: Spontaneous carotid cavernous fistula on the right side. Endovascular embolization of vessels with occlusion of the indirect CSA of the right NSA basin with non-adhesive liquid composite material based on ethylene-vinyl alcohol copolymer (EVOH) was performed. Regression of ophthalmologic picture was noted in the postoperative period. Results . Against the background of atherosclerosis of cerebral vessels, hypertension, the right external carotid artery basin (right middle meningeal artery) as well as meningeal branches of both internal carotid arteries with discharge into the right carotid-cavernous sinus and right ophthalmic vein was formed. Conclusion. In spontaneous carotid cavernous fistula with small fistula size, the clinical picture of the disease may not have classical symptoms, causing difficulties in diagnosis and leading to inappropriate treatment tactics. To detect complex vascular disorders, it is important to use brain MRI in vascular mode as an additional method of investigation. Early diagnosis and targeted treatment are the key to a favorable outcome and successful rehabilitation of the patient.