Relationship of clinical presentation and angiographic findings in patients with indirect cavernous carotid fistulae
| Autor: | Danial K. Hallam, Basavaraj Ghodke, Matthew D Alexander, Daniel L Cooke, Steven W. Hetts, Randall T. Higashida, Matthew R Amans, Van V. Halbach, Christopher F. Dowd, Philip M. Meyers |
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| Rok vydání: | 2018 |
| Předmět: |
Chemosis
Adult Carotid Artery Diseases Male medicine.medical_specialty Fistula 03 medical and health sciences 0302 clinical medicine Carotid-Cavernous Sinus Fistula Occlusion medicine Diplopia Humans Prospective Studies Aged Retrospective Studies medicine.diagnostic_test business.industry Reflux Inferior petrosal sinus General Medicine Middle Aged medicine.disease Cranial Nerve Diseases Cerebral Angiography medicine.anatomical_structure Angiography 030221 ophthalmology & optometry Surgery Female Neurology (clinical) Radiology medicine.symptom business 030217 neurology & neurosurgery Carotid Artery Internal Orbit (anatomy) |
| Zdroj: | Journal of neurointerventional surgery. 11(9) |
| ISSN: | 1759-8486 |
| Popis: | IntroductionIndirect cavernous carotid fistulae (ICCFs) can present with insidious, non-specific symptoms and prove difficult to diagnose. This study evaluates associations among ICCF symptoms and angiographic findings.MethodsA retrospective analysis was performed of prospectively maintained records at four medical centers to identify patients with ICCFs evaluated with angiography. Patient demographics, symptoms, and angiographic findings were tabulated. Univariate and multivariate analyses were conducted to identify associations among these variables.ResultsRecords sufficient for review existed for 267 patients evaluated with angiography. Patients were most commonly women, in the sixth or seventh decade of life, and had symptoms for months before a definitive diagnosis. The most common symptoms included proptosis, diplopia, cranial nerve palsy, and chemosis. Cortical venous reflux was most common in patients with chemosis, orbital pain, or bruit. Intracranial hemorrhage was associated with cortical reflux and bilateral inferior petrosal sinus occlusion. Patients with loss of symptoms demonstrated higher rates of inferior petrosal sinus occlusion and a trend towards rupture.ConclusionA high index of suspicion is needed to promptly diagnose patients with ICCFs. High risk features are more common in the setting of chemosis, orbital pain, bruit, or spontaneous loss of symptoms. Patients with such symptoms warrant expedited angiographic evaluation. |
| Databáze: | OpenAIRE |
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