Headache with vision loss
Large cavernous sinus with signal voids ( t1w) .
TI ( C) :
Enlarged enhancing cavernous sinus and SOV.
Adjacent or diffuse dural enhancement .
Increased flow related signal in the CS .
Increased signal void in CS : Due to increased turbulence
Flow in SOV and /or trans-sellar collaterals
Diagnosis: Carotico Carvernous fistula
—Blood from cavernous ICA to CS ..SOV and petrosal sinuses.
—Reflux from cerebral cortical veins occurs when SOV/IOV and petrosal sinuses cannot handle large blood volume …increased risk of SAH .
Etiology & Types?—Skull base fracture commonest .
—Ruptured cavernous ICA aneurysm .
—Younger individuals (prone to trauma ) average age ( 37 years) . Gender : male .
—Individual with collagen vascular disorders
—Most tears involve the proximal horizontal or vertical cavernous ICA .
—Type A : Direct communication between ICA and cavernous sinus
—Type B-D : Indirect communications between the meningeal/dural branches of ICA/ECA and cavernous sinus
Clinical Findings?—Symptoms develop either spontaneously or days / wks after trauma
Bruit ( 50%) , pulsating exophthalmos , orbital edema / erythema , decrease vision, glaucoma , headache . Severe rapid vision loss ,SAH , Focal deficits ( CN 3-6). ( these findings may be unilateral / bilateral)
Treatment?—Spontaneous thrombosis rare , progresses if untreated .
—ICA / JUGULAR vein compression ..only for small CCF
—Embolization (coiling or balloon) : Trans-arterial or transvenous .
—Surgery / Gamma knife
Dr Ritesh Mahajan