Ophthalmology Series: Case 6

ANSWERS WILL BE POSTED AT 18:00 CET

A 68 year-old retired construction worker presented to A&E with a sudden onset of a red and proptosed eye with pulsatile tinnitus. Eye movements are reduced in all directions but vision is intact.
His past medical history revealed that he had a severe head injury eight years ago.

Selective Angiography reveals:

1. What is the most likely diagnosis ?

2. Outline the pathology of this disease.

3. How would you clinically confirm this diagnosis ?

4. Which imaging modalities are used to investigate ?

5. How would you manage this patient ? 

Source: https://www.ncbi.nlm.nih.gov/pubmed/27781074

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5 thoughts on “Ophthalmology Series: Case 6

  1. ANSWERS
    1. Carotid-Cavernous sinus fistula
    2. Carotid-cavernous sinus fistulae occur due to traumatic events in the walls of the intracavernous internal carotid artery or its branches. As a result, arterial blood enters the cavernous sinus under high pressure. Normal venous return is disrupted and causes engorgement of the draining veins.
    3. A bruit can be auscultated due to the high blood flow in the arterio-venous fistula.
    4. Imaging includes MRI, MR angiography and a CT scan.
    A cerebral DSA showcases the fistula under high magnification power.
    5. Endovascular repair of the fistula is the mainstay of treatment.

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