• World Neurosurg · May 2020

    Case Reports

    Cavernous-Carotid Fistula Presenting with Intracerebral Hemorrhage in the Absence of Ocular Symptoms: a case report.

    • Nikolaos Mouchtouris, Michael J Lang, Anthony Stefanelli, William Hirsch, Stavropoula Tjoumakaris, M Reid Gooch, Robert Rosenwasser, and Pascal M Jabbour.
    • Department of Neurological Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA.
    • World Neurosurg. 2020 May 1; 137: 338-340.

    BackgroundCavernous-carotid fistulas (CCFs) can present with a variety of symptoms depending on the anatomy of the fistula and its venous drainage. Patients most commonly present with scleral injection, pulsatile exophthalmos, and/or chemosis.Case DescriptionWe report a patient who presented with intraparenchymal hemorrhage in the absence of any of the commonly associated ocular symptoms and signs. After multiple imaging studies, the CCF was diagnosed and treated with endovascular embolization that resulted in complete occlusion of the fistula and reflux of embolysate into one of its connecting veins.ConclusionsThe morphology of the venous drainage can lead to atypical hemorrhagic presentation, whereas dilatation of one of the tributary veins with cortical venous reflux should warn the interventionist the path the embolysate may follow. We provide our experience with this unique presentation and its treatment.Copyright © 2020 Elsevier Inc. All rights reserved.

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