Bilateral blunt cerebrovascular injury resulting in direct carotid-cavernous fistulae: A case report and review of the literature
| Autor: | Matthew D Alexander, Michael Karsy, Stephanie V Avila, Brooke Van Noy, John D. Rolston |
|---|---|
| Jazyk: | angličtina |
| Rok vydání: | 2018 |
| Předmět: |
medicine.medical_specialty
business.industry Glasgow Coma Scale 030204 cardiovascular system & hematology medicine.disease Intraoperative Hemorrhage Hypertonic saline Surgery 03 medical and health sciences 0302 clinical medicine Epidural hematoma Hematoma medicine.anatomical_structure Blunt dissection Trauma: Case Report Carotid canal Medicine Neurology (clinical) business carotid-cavernous fistula Carotid-cavernous fistula 030217 neurology & neurosurgery Blunt cerebrovascular injury |
| Zdroj: | Surgical Neurology International |
| ISSN: | 2152-7806 2229-5097 |
| Popis: | Background Bilateral blunt cerebrovascular injury (BCVI) has been documented in 32 patients in the English-language literature and bilateral carotid-cavernous fistulae (CCFs) have been reported in only 1 patient. Here, we present a case of severe, unexpected bilateral BCVI with bilateral direct CCF and review the literature of BCVI, particularly cases of bilateral injury. Case description A 65-year-old woman with episodic bradycardia presented after a motor vehicle accident. On arrival, she had a Glasgow Coma Scale of 3T and progressive dilation of her right pupil. Computed tomography imaging showed a 1.8-cm right epidural hematoma (EDH) with 6 mm of right-to-left shift. No acute skull-base fracture or injury in the area of the carotid canal was noted. The patient was treated with 3% hypertonic saline and mannitol before being taken to the operating room for emergent decompression of the hematoma. Although the patient initially presented with an EDH, significant intraoperative hemorrhage was identified during surgical evacuation and later confirmed as bilateral direct CCFs during angiographic evaluation. Because of the patient's devastating injuries, life-extending measures were not continued and the patient died. Conclusions A review of the literature indicates that bilateral CCFs are rare, having been reported only once previously. As this case demonstrates, CCFs may occur in high-energy injuries and should be considered even if the patient does not meet traditional screening criteria. |
| Databáze: | OpenAIRE |
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