Venous Stasis Retinopathy Complicating a Case of Cavernous-carotid Fistula with an Initial Normal Computed Tomography Angiogram of the Brain
Cavernous-carotid Fistula with Venous Stasis Retinopathy
Abstract
Carotid-cavernous fistula (CCF) can be spontaneous or due to trauma. Due to its complication to the eye, diagnosis and intervention should not be delayed. We report a case of an elderly female who presented with left eye redness with gradual onset of protrusion over the same eye. She was suspected to have CCF with the clinical presentation. Nevertheless, she had a normal computed tomography angiogram of the brain. Later, she was scheduled for cerebral angiography and the diagnosis of CCF was confirmed. However, due to delay in diagnosis and treatment, the patient developed venous stasis retinopathy and neovascular glaucoma. Her vision remained poor despite aggressive systemic and ocular treatments. This case report is to emphasise the importance of clinical suspicion of a disease despite a normal imaging. This is to prevent irreversible blindness and other systemic complications.
Keywords :
Carotid-cavernous fistula,
cerebral angiography,
neovascular glaucoma,
Abstrak
'Carotid-cavernous fistula' (CCF) boleh berlaku secara spontan atau akibat kecederaan. Disebabkan komplikasi pada mata, proses mengenalpasti penyakit dan rawatan tidak harus ditangguhkan. Kami ingin melaporkan satu kes di mana seorang wanita tua yang mengalami kemerahan mata dan kemudiannya mata menjadi semakin bengkak. Beliau disyaki menghidapi penyakit CCF tetapi pemeriksaan imbasan tomografi berkomputer pada otak dilaporkan normal. Pesakit kemudiannya dijadualkan untuk cerebral angiografi dan beliau dikenalpasti menghidap penyakit CCF. Malangnya, pesakit tersebut mengalami komplikasi seperti retinopati stasis vena dan glaukoma neovascular disebabkan rawatan tergendala. Penglihatan beliau tidak dapat disembuhkan walaupun rawatan agresif telah diberikan. Kes ini bertujuan untuk menekankan kepentingan mengesyaki sesuatu penyakit melalui pemeriksaan klinikal walaupun dengan imbasan imej yang normal. Ini adalah untuk mengelakkan komplikasi seperti kebutaan yang tidak dapat disembuhkan.
Kata Kunci :
cerebral angiografi,
Fistula carotid-cavernous,
glaukoma neovascular,
Correspondance Address
Safinaz Mohd Khialdin. Department of Ophthalmology, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Jalan Yaacob Latiff, Bandar Tun Razak, 56000 Cheras, Kuala Lumpur, Malaysia. Tel: +603-91455981 Email: drsafinaz_1978@yahoo.com.my
