Carotid-cavernous sinus fistula presenting with contralateral intracerebral haemorrhage

Abstract

Carotid-cavernous fistula is a well-established neurological disease that typically presents with proptosis, chemosis, ophthalmic bruit, and cranial nerve palsies. This report is of an atypical case of carotid-cavernous fistula that resulted in contralateral intracerebral haemorrhage. A 28-year-old woman presented with sudden headache and was found to have a right temporal intracerebral haemorrhage. She did not have ocular symptoms such as proptosis or chemosis. Angiographic studies revealed a left-sided direct-type (Barrow type A) carotid-cavernous fistula and no other significant findings. The left type A carotid-cavernous fistula was likely to have caused venous hypertension around the contralateral cerebral hemisphere and intracerebral haemorrhage by means of intercavernous venous cross-flow. This patient was also unusual in that the type A carotid-cavernous fistula, which rarely resolves without intervention, had disappeared spontaneously four days later. Carotid-cavernous fistula should be considered as a differential diagnosis in patients with spontaneous intracerebral haemorrhage, even in the absence of ocular symptoms. Investigations should include thorough angiographic studies of the contralateral cerebral vessels.

頸內動脈海綿竇瘻是一種已知的神經性疾病，症狀為眼球突出、球結膜水腫、眼雜音及顱神經麻 痺。本文報告一宗頸內動脈海綿竇瘻的非典型病例，病徵為對側腦內出血。一名28歲女性有突發性 頭痛，發現為右腦顳叶出血。病人未有出現如眼球突出或球結膜水腫，但其血管造影結果顯示左側 一直接型（即甲型Barrow）的頸內動脈海綿竇瘻。除此以外，並無其他嚴重疾病。此左邊甲型海綿 竇瘻造成竇內靜脈對流，引致對側大腦半球的靜脈高壓和腦內出血。這種甲型海綿竇瘻很少會自行 緩解。可是這名病人的頸內動脈海綿竇瘻在四日後自動緩解。如果病人出現自發性腦出血，縱使未 有眼部症狀，都應考慮頸內動脈海綿竇瘻鑒別診斷的可能性。應為病人的對側腦血管進行徹底的血 管造影檢查。