Extensive basal ganglia edema caused by a traumatic carotid-cavernous fistula: a rare presentation related to a basal vein of Rosenthal anatomical variation

2014 ◽  
Vol 121 (1) ◽  
pp. 63-66 ◽  
Author(s):  
Isabelle Ract ◽  
Aurélie Drier ◽  
Delphine Leclercq ◽  
Nader Sourour ◽  
Joseph Gabrieli ◽  
...  
Keyword(s):  
Basal Ganglia ◽  
Vasogenic Edema ◽  
Anatomical Variation ◽  
Brain Mri ◽  
Venous Congestion ◽  
Carotid Cavernous Fistula ◽  
Orbital Trauma ◽  
Rare Presentation ◽  
Cavernous Fistula ◽  
Basal Vein Of Rosenthal

The authors report a very rare presentation of traumatic carotid-cavernous fistula (CCF) with extensive edema of the basal ganglia and brainstem because of an anatomical variation of the basal vein of Rosenthal (BVR). A 45-year-old woman was admitted to the authors' institution for left hemiparesis, dysarthria, and a comatose state caused by right orbital trauma from a thin metal rod. Brain MRI showed a right CCF and vasogenic edema of the right side of the brainstem, right temporal lobe, and basal ganglia. Digital subtraction angiography confirmed a high-flow direct CCF and revealed a hypoplastic second segment of the BVR responsible for the hypertension in inferior striate veins and venous congestion. Endovascular treatment was performed on an emergency basis. One month after treatment, the patient's symptoms and MRI signal abnormalities almost totally disappeared. Basal ganglia and brainstem venous congestion may occur in traumatic CCF in cases of a hypoplastic or agenetic second segment of the BVR and may provoke emergency treatment.

scholarly journals Contralateral extensive cerebral hemorrhagic venous infarction caused by retrograde venous reflux into the opposite basal vein of Rosenthal in posttraumatic carotid-cavernous fistula: A case report and literature review

2018 ◽  
Vol 24 (5) ◽  
pp. 546-558 ◽  
Author(s):  
Prasert Iampreechakul ◽  
Adisak Tanpun ◽  
Punjama Lertbusayanukul ◽  
Somkiet Siriwimonmas
Keyword(s):  
Basal Ganglia ◽  
Magnetic Resonance ◽  
Endovascular Treatment ◽  
Motor Vehicle ◽  
Motor Vehicle Accident ◽  
Venous Reflux ◽  
Carotid Cavernous Fistula ◽  
Venous Infarction ◽  
Cavernous Fistula ◽  
Basal Vein Of Rosenthal

We describe a patient with traumatic carotid-cavernous fistula (CCF), subsequently developing contralateral extensive hemorrhagic venous infarction from retrograde venous reflux into the opposite basal vein of Rosenthal. A 54-year-old woman was involved in a motor vehicle accident and sustained severe traumatic brain injury. Two months later, she developed bilateral proptosis and audible bruit. Magnetic resonance imaging (MRI) and magnetic resonance angiography (MRA) of the brain demonstrated the right direct CCF. Fluid-attenuated inversion recovery (FLAIR) images showed a small hyperintense area at the left basal ganglia. Ten days later, she developed right-sided grade 2/5 hemiparesis, facial upper motor neuron weakness, and cognitive impairment. Follow-up MRI showed significant progression of hyperintensities involving the left-sided centrum semiovale, basal ganglia, thalamus, midbrain, pons, cerebellum, basal frontal, temporal lobes, especially subcortical white matter on FLAIR images, and multiple hypointense foci of hemorrhagic component on T2*-weighted gradient-echo images, representing hemorrhagic venous infarction. While waiting for embolization, she rapidly developed right hemiplegia and aphasia, and became somnolent. Under general anesthesia, emergency endovascular treatment was performed successfully to obliterate the fistula without surgical intervention. Five months after endovascular treatment, MRI and MRA confirmed no residual fistula and revealed nearly complete resolution of abnormal increased signal intensity. In the present case, the factors related to the presence of this rare condition were absence of the ipsilateral basal vein of Rosenthal (BVR), occlusion of posterior segment of the contralateral superior petrosal sinus, and a developed uncal vein with hypoplastic second and third segments of the contralateral BVR.

scholarly journals Post-traumatic carotid-cavernous fistula with bilateral proptosis simulating cavernous sinus thrombosis

2019 ◽  
Vol 12 (3) ◽  
pp. e227757 ◽  
Author(s):  
Nirupama Kasturi ◽  
Pooja Kumari ◽  
Gayatri Nagarajan ◽  
Nagarajan Krishnan
Keyword(s):  
Cavernous Sinus ◽  
Sinus Thrombosis ◽  
Cavernous Sinus Thrombosis ◽  
Coil Embolisation ◽  
Carotid Cavernous Fistula ◽  
Orbital Trauma ◽  
Cavernous Fistula ◽  
Intravenous Antibiotics ◽  
Post Traumatic

A 48-year-old woman presented with bilateral non-pulsatile proptosis and ophthalmoplegia after 3 days following blunt orbital trauma. It was associated with fever, malaise and loss of vision in right eye. She was provisionally diagnosed with cavernous sinus thrombosis and was treated with intravenous antibiotics with no improvement. A subtle bruit was present on examination, and digital subtraction angiography revealed a right direct (type A) carotid-cavernous fistula (CCF). The patient underwent right coil embolisation of direct CCF. On follow-up at 4 months, her proptosis resolved completely and extraocular movements improved.

Orbitofrontal Extradural Hematoma: Unusual Cause of Proptosis

2021 ◽  
Author(s):  
Satish Verma ◽  
Shweta Kumari
Keyword(s):  
Management Strategy ◽  
Venous Congestion ◽  
Extradural Hematoma ◽  
Carotid Cavernous Fistula ◽  
Distinct Entity ◽  
Cavernous Fistula

Traumatic orbital subperiosteal hematoma are a distinct entity and should not be confused with orbital extradural hematoma. Most of the orbital subperiosteal hematoma are small in volume and resolve spontaneously. Management should be based on the clinico-radiological condition. A delayed proptosis may be simply due to orbital venous congestion due to a substantial hematoma or due to a carotid-cavernous fistula. Differentiation between the two is paramount to decide management strategy.

Pontine venous congestion caused by dural carotid-cavernous fistula: report of two cases

1997 ◽  
Vol 7 (3) ◽  
pp. 405-408 ◽  
Author(s):  
A. Uchino ◽  
A. Kato ◽  
Y. Kuroda ◽  
S. Shimokawa ◽  
S. Kudo
Keyword(s):  
Venous Congestion ◽  
Carotid Cavernous Fistula ◽  
Cavernous Fistula

scholarly journals Acute Transverse Myelitis (Ascending Myelitis) as the Initial Manifestation of Japanese Encephalitis: A Rare Presentation

2013 ◽  
Vol 2013 ◽  
pp. 1-3
Author(s):  
Varshney Ankur Nandan ◽  
Kumar Nilesh ◽  
Behera Dibyaranjan ◽  
Tiwari Ashutosh ◽  
Anand Ravi ◽  
...  
Keyword(s):  
Japanese Encephalitis ◽  
Vasogenic Edema ◽  
Brain Mri ◽  
Transverse Myelitis ◽  
Internal Capsule ◽  
Endemic Region ◽  
Rare Presentation ◽  
Initial Manifestation ◽  
Altered Sensorium ◽  
Acute Transverse Myelitis

Japanese encephalitis, an inflammatory brain disease prevalent in Southeast Asia, usually presented with fever, headache, convulsions, brain stem signs with pyramidal and extrapyramidal features, and altered sensorium. Acute transverse myelitis, as the initial manifestation of Japanese encephalitis, is an unusual manifestation and is seldom reported. We hereby report a case of 13-year-old adolescent boy who presented to us with fever and acute onset paraparesis with urinary retention initially, progressing to quadriparesis and then followed by headache and altered sensorium. Brain MRI revealed bilateral basal ganglia that were grossly swollen with vasogenic edema tracking along internal capsule and midbrain. Adjacent ventrolateral thalamus and internal capsule also showed mild abnormal intensities. Spinal screening showed abnormal cord intensities in entire cord with gross edema in cervical and conus regions. He had elevated IgM titres against JE virus in cerebrospinal fluid. The patient was treated conservatively along with intravenous methyl prednisolone for 5 days. He regained near normal power at 3 months in followup, but hesitancy, dysarthria, and slowness of movement still persisted. To conclude, a young boy presenting with ATM in an endemic region of JE, then a possibility of Japanese encephalitis, should be sought by clinicians as early use of immunomodulator shows survival benefit.

scholarly journals Isolated abducens palsy of advanced age: a rare presentation of dural carotid cavernous fistula: a case report

2018 ◽  
Vol 29 ◽  
Author(s):  
Dilek Yilmaz ◽  
Asli Akyol Gurses ◽  
Koray Akkan ◽  
Yusuf Oner ◽  
Erhan Ilgit ◽  
...  
Keyword(s):  
Case Report ◽  
Advanced Age ◽  
Abducens Palsy ◽  
Carotid Cavernous Fistula ◽  
Rare Presentation ◽  
Cavernous Fistula

Direct Carotid-Cavernous Fistula Causing Brainstem Venous Congestion

2009 ◽  
Vol 29 (1) ◽  
pp. 21-25 ◽  
Author(s):  
Miguel Bussière ◽  
Stephen P Lownie ◽  
David M Pelz ◽  
David Nicolle
Keyword(s):  
Venous Congestion ◽  
Carotid Cavernous Fistula ◽  
Cavernous Fistula ◽  
Direct Carotid Cavernous Fistula
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