Journal of neuro-ophthalmology : the official journal of the North American Neuro-Ophthalmology Society
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Case Reports
Restricted diffusion in the superior ophthalmic vein and cavernous sinus in a case of cavernous sinus thrombosis.
A previously healthy 14-year-old boy developed headache, stiff neck, fever, diplopia, right proptosis, and right complete sixth and partial third cranial nerve palsies. Orbital CT showed features of pansinusitis and orbital fat stranding. An initial diagnosis of orbital cellulitis was made. ⋯ CT venography (CTV) confirmed these features and disclosed nonobstructing thrombus within the left sigmoid sinus and proximal segments of both internal jugular veins. MRI with diffusion imaging disclosed evidence of restricted diffusion within the SOV and cavernous sinuses. These diffusion imaging findings, which may be analogous to those reported with brain parenchymal hematoma, have been described sparingly in intravascular hematoma.
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Endovascular occlusion via the transvenous route is the favored treatment method for dural carotid-cavernous fistulas (CCFs). Ethylene vinyl alcohol copolymer (Onyx), recently approved for treatment of arteriovenous malformations, has advantages over conventional liquid embolic agents in its nonadhesive nature, which allows for longer injections with decreased risk of catheter retention. We report the use of Onyx in the successful transarterial embolization of a dural CCF fed by arterial branches of the internal and external carotid arteries (Barrow type D) after multiple failed attempts to access the cavernous sinus transvenously. Transarterial Onyx embolization could be a valuable option in transarterial treatment of CCFs when venous access is difficult.
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Letter Case Reports
Opsoclonus caused by diphenhydramine self-poisoning.