TY - JOUR
T1 - Reversal of blindness after transvenous embolization of a carotid-cavernous fistula
T2 - Case report
AU - Albuquerque, Felipe C.
AU - Heinz, Grant W.
AU - McDougall, Cameron G.
AU - Rosenwasser, Robert H.
AU - Bendok, Bernard R.
AU - Hopkins, L. Nelson
AU - Steinberg, Gary K.
AU - Zielinski, Steven C.
AU - Higashida, Randall T.
PY - 2003/1/1
Y1 - 2003/1/1
N2 - OBJECTIVE AND IMPORTANCE: Reversal of blindness after the endovascular treatment of a carotid-cavernous fistula (CCF) is exceedingly rare. It has been reported only once in a patient with a direct CCF. We report the first such case in a patient with an indirect CCF. Defining patients whose vision may recover is critical in coordinating the timing of therapy. Mechanisms of reversible visual loss in CCFs are discussed with the intent of elucidating the patients who compose this subgroup. CLINICAL PRESENTATION: A 65-year-old man had a 1 -week history of blindness, chemosis, and proptosis of the right eye. Ophthalmoscopy was compromised by diffuse choroidal effusion and corneal edema that obscured visualization of the patient's retina. INTERVENTION: Transvenous embolization through retrograde catheterization of the superior ophthalmic vein allowed complete coil occlusion of the lesion. The patient's visual loss improved rapidly, returning to normal within 50 days. CONCLUSION: Although CCFs frequently are associated with permanent visual loss, a subset of patients demonstrates reversible ocular findings. If the retina of a patient with a CCF seems normal or is obscured, the potential for visual recovery, even from blindness, should prompt emergent treatment.
AB - OBJECTIVE AND IMPORTANCE: Reversal of blindness after the endovascular treatment of a carotid-cavernous fistula (CCF) is exceedingly rare. It has been reported only once in a patient with a direct CCF. We report the first such case in a patient with an indirect CCF. Defining patients whose vision may recover is critical in coordinating the timing of therapy. Mechanisms of reversible visual loss in CCFs are discussed with the intent of elucidating the patients who compose this subgroup. CLINICAL PRESENTATION: A 65-year-old man had a 1 -week history of blindness, chemosis, and proptosis of the right eye. Ophthalmoscopy was compromised by diffuse choroidal effusion and corneal edema that obscured visualization of the patient's retina. INTERVENTION: Transvenous embolization through retrograde catheterization of the superior ophthalmic vein allowed complete coil occlusion of the lesion. The patient's visual loss improved rapidly, returning to normal within 50 days. CONCLUSION: Although CCFs frequently are associated with permanent visual loss, a subset of patients demonstrates reversible ocular findings. If the retina of a patient with a CCF seems normal or is obscured, the potential for visual recovery, even from blindness, should prompt emergent treatment.
KW - Blindness
KW - Carotid-cavernous fistula
KW - Transvenous embolization
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U2 - 10.1097/00006123-200301000-00031
DO - 10.1097/00006123-200301000-00031
M3 - Article
C2 - 12493124
AN - SCOPUS:0037234928
SN - 0148-396X
VL - 52
SP - 233
EP - 237
JO - Neurosurgery
JF - Neurosurgery
IS - 1
ER -