MyMedR

Fulltext Venous stasis retinopathy complicating a case of cavernous-carotid fistula with an initial normal computed tomography angiogram of the brain

Cheng, T.C., Jemaima, C.H., Safinaz, M.K.

Medicine & Health, 2020;15(2):313-320.

MyJurnal

'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.

Matched MeSH terms: Carotid-Cavernous Sinus Fistula

Cavernous sinus fungal infection: a rare case

Ng BHK, Kho GS, Sim SK, Liew DNS, Tang IP

Br J Neurosurg, 2017 Jun 09.

PMID: 28597698 DOI: 10.1080/02688697.2017.1335857

Intracranial fungal infection of the cavernous sinus is a condition that usually affects immunocompromised individuals and is rarely seen in immunocompetent individuals. It is a potentially life threatening condition which requires prompt treatment. Here we present a case of an immunocompetent patient with a fungal infection of the cavernous sinus.

Matched MeSH terms: Cavernous Sinus

Fulltext Images in clinical medicine. Carotid-cavernous sinus fistula

Govindaraju R, Narayanan P

N Engl J Med, 2016 Mar 31;374(13):e15.

PMID: 27028934 DOI: 10.1056/NEJMicm1509943

Matched MeSH terms: Cavernous Sinus/radiography; Carotid-Cavernous Sinus Fistula/complications; Carotid-Cavernous Sinus Fistula/radiography*

Fulltext Ptosis due to cavernous sinus syndrome as a rare presentation of advanced breast metastasis in a patient with delayed diagnosis

Khaw K, Ramli N, Rahmat K

Malays Fam Physician, 2012;7(1):31-3.

PMID: 25606243 MyJurnal

Complications of breast cancer metastasis may be the first manifestation of the disease. We report a rare case of left eye ptosis secondary to cavernous sinus syndrome in a 34-year-old lady due to refusal of proper medical treatment for metastatic breast cancer. The delay in seeking medical treatment was attributed to her use of Traditional Chinese Medicine (TCM).

Matched MeSH terms: Cavernous Sinus; Cavernous Sinus Thrombosis

Fulltext Supraclinoid direct carotid-cavernous sinus fistula

Che Ani MF, Kumar R, Md Noh MSF, Muda AS

BJR Case Rep, 2018 Mar;4(3):20170058.

PMID: 31489208 DOI: 10.1259/bjrcr.20170058

Carotid-cavernous fistulas (CCFs) are vascular shunts between the carotid arterial system with direct drainage into the cerebral venous system, mainly to the cavernous sinus. Direct CCF is a well-recognised complication following head trauma. Classically in direct or traumatic CCF, vessel wall tear occurs at the cavernous segment of the internal carotid artery, between the fixed and free segment. Tears at the supraclinoid segment are rare. We report a case of an internal carotid artery supraclinoid segment pseudoaneurysm, with a direct communication with the cavernous sinus, draining into the superior ophthalmic vein.

Matched MeSH terms: Cavernous Sinus; Carotid-Cavernous Sinus Fistula

Fulltext Recurrent cavernous sinus thrombosis: a rare complication of Cushing disease

Tong CV, Tee CK

BMJ Case Rep, 2021 Jun 22;14(6).

PMID: 34158336 DOI: 10.1136/bcr-2021-243786

A 14-year-old girl who presented in 2017 with headache, unilateral right eye ptosis and secondary amenorrhoea had an initial workup consistent with non-functioning pituitary macroadenoma. She underwent debulking of pituitary tumour in October 2017. Postoperatively, she developed recurrent cavernous sinus thrombosis. In view of recurrent thrombosis, she was reinvestigated and was found to have adrenocorticotropic hormone-dependent Cushing. Follow-up MRI 1 year after initial presentation showed that there was structural recurrence of pituitary macroadenoma. She subsequently underwent a petrosal craniotomy for debulking of tumour. Postsurgery she remained biochemically Cushingnoid. MRI 5 months after second surgery showed an enlarging pituitary mass which was deemed inoperable. A multidisciplinary meeting discussion consensus for treatment included radiotherapy and somatostatin analogue, pasireotide. She completed 30 cycles of radiotherapy and MRI post radiotherapy showed reduction in the size of the macroadenoma. Currently, she is waiting for pasereotide initiation.

Matched MeSH terms: Cavernous Sinus Thrombosis*

Magnetic resonance angiographic demonstration of carotid-cavernous fistula using elliptical centric time resolved imaging of contrast kinetics (EC-TRICKS)

Vattoth S, Cherian J, Pandey T

Magn Reson Imaging, 2007 Oct;25(8):1227-31.

PMID: 17442526

Magnetic resonance angiographic evaluation of the intracranial vasculature has been predominantly carried out using conventional angiographic techniques such as time of flight and phase contrast sequences. These techniques have good spatial resolution but lack temporal resolution. Newer faster angiographic techniques have been developed to circumvent this limitation. Elliptical centric time-resolved imaging of contrast kinetics (EC-TRICKS) is one such technique which has combined the use of elliptical centric ordering of the k-space with multiphase 3D digital subtraction MR angiogram (MRA) to achieve excellent temporal resolution of the arterial and venous circulations. Its applications have been mainly in the peripheral vasculature. We report the use of this technique in a case of a high-flow, direct carotid-cavernous fistula to demonstrate its potential in intracranial MR angiography.

Matched MeSH terms: Carotid-Cavernous Sinus Fistula/diagnosis*

Cavernous sinus thrombosis secondary to sinusitis

Amran M, Sidek DS, Hamzah M, Abdullah JM, Halim AS, Johari MR, et al.

J Otolaryngol, 2002 Jun;31(3):165-9.

PMID: 12121021

Matched MeSH terms: Cavernous Sinus Thrombosis/diagnosis; Cavernous Sinus Thrombosis/drug therapy; Cavernous Sinus Thrombosis/etiology*

Fulltext Post-traumatic Carotico-cavernous fistula: A report of two cases

Primuharsa Putra. S.H.A., Nurliza, I., Roszalina, R., Saim, L., Zahiah, M.

International Medical Journal Malaysia, 2007;6(2):1-8.

MyJurnal

We present two cases of direct traumatic carotico-cavernous fistula following motor vehicle accident. Their main symptoms include loss of vision, progressive proptosis and recurrent epistaxis. Angiogram confirmed presence of carotico-cavernous fistula in both cases. One was successfully treated by open surgery and the other by embolization with Guglielmi detachable coils (GDC). In both cases, proptosis and epistaxis resolved completely.

Matched MeSH terms: Cavernous Sinus

Fulltext Right internal carotid pseudoaneurysm mimicking a retropharyngeal abscess in a child

Lee NNA, Long G, Ngai S, Sahrir S, Parker A, Lamont AC

Med J Malaysia, 2004 Dec;59(5):685-7.

PMID: 15889576

A 7-year-old girl with tonsillar infection with antibiotics. Two weeks later, there was a right sided neck lump. Computed tomography scans demonstrated a predominantly hypodense right retropharyngeal area with peripheral enhancement and mass effect. There was intense enhancement within the postero-superior aspect of the lesion which was continuous with the right internal carotid artery. Ultrasound demonstrated tapering of the right internal carotid artery. Magnetic resonance imaging and magnetic resonance arteriography showed a right internal carotid artery pseudoaneurysm. Surgical exploration confirmed the finding. This case highlights an unusual presentation of an internal carotid pseudoaneurysm and how imaging provided the diagnosis.

Matched MeSH terms: Carotid-Cavernous Sinus Fistula/diagnosis*; Carotid-Cavernous Sinus Fistula/surgery

Fulltext Atypical Cavernous Sinus Thrombosis: A Diagnosis Challenge and Dilemma

Matthew TJH, Hussein A

Cureus, 2018 Dec 04;10(12):e3685.

PMID: 30761237 DOI: 10.7759/cureus.3685

Cavernous sinus thrombosis (CST) is an ocular emergency because of its devastating effect and it is prone to cause serious complications. Diagnosis of cavernous sinus thrombosis is a challenging task despite medical advancement. Efforts to promptly diagnose and initiate treatment require a high index of suspicion and a deep understanding of the disease. Unfortunately, patients suffering from CST may not always present with typical symptoms, thus making diagnosis all the more challenging. We would like to describe a 22-year-old man who presented with atypical symptoms and radiological presentations of CST. The patient was admitted and treated in our institution with full recovery demonstrated after the treatment.

Matched MeSH terms: Cavernous Sinus Thrombosis

Fulltext Endocrinological Outcome of Endoscopic Transsphenoidal Surgery for Functioning and Non-Functioning Pituitary Adenoma

Yi LS, Alias A, Ghani ARI, Bidin MBL

Malays J Med Sci, 2019 May;26(3):64-71.

PMID: 31303851 MyJurnal DOI: 10.21315/mjms2019.26.3.5

Introduction: The present study analysed the (i) remission and preservation of hormones, (ii) endocrinological and anatomical complications and (iii) visual improvement after endoscopic transsphenoidal surgery (ETS).

Methods: The retrospective observational study of all consecutive cases of pituitary adenoma treated with ETS in Hospital Kuala Lumpur (HKL) between 2006 and 2015. Age, sex, pre- and post-operative hormone level, tumour size, and complications were noted.

Results: A total of 67 patients were diagnosed with non-functioning pituitary adenoma throughout this period. Of these, 11 patients had both visual and hormonal improvement post-operation. Of the 27 patients with tumour invaded into the cavernous sinus, 13 showed an improved vision. In the adenoma patients who had impaired hormonal function before the surgery, the hormone level normalised post-surgery in 42 patients. Moreover, 39 patients were diagnosed with functioning pituitary adenoma. Ten patients recovered from acromegaly and four patients recovered from Cushing disease within seven days post-operative. Also, five patients with functioning adenoma suffered complications.

Conclusion: Outcome for the preservation and hormone recovery in non-functioning pituitary adenoma group was satisfactory, with only one patient's hormonal level worsening. No visual deterioration and mortality were detected throughout this study. A dedicated team specialised in endoscopic transsphenoidal pituitary surgery further improved the outcome of this surgical method.

Matched MeSH terms: Cavernous Sinus

Fulltext Massive epistaxis secondary to pseudoaneurysm of internal carotid artery

Abdullah A, Putra SH, Saim L

Med J Malaysia, 2006 Mar;61(1):84-7.

PMID: 16708739 MyJurnal

Post-traumatic pseudoaneurysms of internal carotid arteries are uncommon. The patients may present with massive epistaxis due to rupture of the aneurysm into the sphenoid sinus. Early diagnosis and treatment is mandatory as the likelihood of exsanguinations increases with each subsequent episode of epistaxis. The clinical features of unilateral blindness and massive epistaxis after head injury should indicate the diagnosis. The high mortality of this entity underlines the importance of early angiography in these patients to confirm this diagnosis. We present 3 cases of post-traumatic aneurysm of the ICA.

Matched MeSH terms: Carotid-Cavernous Sinus Fistula/complications*

Fulltext Arteriovenous malformation in temporal lobe presenting as contralateral ocular symptoms mimicking carotid-cavernous fistula

Mohd-Tahir F, Siti-Raihan I, Wan Hazabbah WH

Case Rep Ophthalmol Med, 2013;2013:158961.

PMID: 23533876 DOI: 10.1155/2013/158961

Aim. To report a rare case of arteriovenous malformation in temporal lobe presenting as contralateral orbital symptoms mimicking carotid-cavernous fistula. Method. Interventional case report. Results. A 31-year-old Malay gentleman presented with 2-month history of painful progressive exophthalmos of his left eye associated with recurrent headache, diplopia, and reduced vision. Ocular examination revealed congestive nonpulsating 7 mm exophthalmos of the left eye with no restriction of movements in all direction. There was diplopia in left lateral gaze. Left IOP was elevated at 29 mmHg. Left eye retinal vessels were slightly dilated and tortuous. CT scan was performed and showed right temporal arteriovenous malformation with a nidus of 3.8 cm × 2.5 cm with right middle cerebral artery as feeding artery. There was dilated left superior ophthalmic vein of 0.9 mm in diameter with enlarged left cavernous sinus. MRA and carotid angiogram confirmed right temporal arteriovenous malformation with no carotid-cavernous fistula. Most of the intracranial drainage was via left cavernous sinus. His signs and symptoms dramatically improved following successful embolisation, completely resolved after one year. Conclusion. Intracranial arteriovenous malformation is rarely presented with primary ocular presentation. Early intervention would salvage the eyes and prevent patients from more disaster morbidity or fatality commonly due to intracranial haemorrhage.

Matched MeSH terms: Cavernous Sinus; Carotid-Cavernous Sinus Fistula

Fulltext Burkitt's lymphoma presenting with hypopituitarism: a case report and review of literature

Foo SH, Sobah SA

Endocrinol Diabetes Metab Case Rep, 2014;2014:140029.

PMID: 25045522 DOI: 10.1530/EDM-14-0029

Hypopituitarism is a rare presentation of Burkitt's lymphoma (BL). The purpose of this report is to present a case of BL presenting with panhypopituitarism and to review other case reports of lymphoma presenting with pituitary dysfunction to highlight the distinguishing features of these cases from other benign aetiologies of pituitary dysfunction such as non-functioning pituitary adenomas. We reviewed a total of 11 cases of lymphoma presenting with pituitary dysfunction published from 1998 to 2013 including the present case. The demographics, clinical presentations, laboratory features, radiological findings, histological diagnosis, treatment administered and outcomes were described. Of the total number of patients, 45.5% of the cases had diffuse large B-cell lymphoma while 27.3% had BL. Anterior pituitary dysfunction was more common than posterior pituitary dysfunction at presentation. The other common associated presenting symptoms were painful ophthalmoplegia, cranial nerve palsies and constitutional symptoms. Hypothalamic-pituitary abnormalities were often demonstrated radiologically to be associated with cavernous sinus and/or stalk involvement. All patients who completed immunochemotherapy responded haematologically. Pituitary dysfunction also improved in most cases although the recovery tended to be partial. In conclusion, a high index of suspicion of underlying malignancy, such as lymphoma, should be present in patients presenting with acute pituitary dysfunction associated with painful ophthalmoplegia, rapidly evolving neurological features, radiological features atypical of a pituitary adenoma and constitutional symptoms. An early diagnosis is essential as prompt initiation of definitive therapy will induce disease remission and recovery of pituitary dysfunction.

Matched MeSH terms: Cavernous Sinus

Bilateral ophthalmic vein thrombosis secondary to nasal furunculosis

Rohana AR, Rosli MK, Nik Rizal NY, Shatriah I, Wan Hazabbah WH

Orbit, 2008;27(3):215-7.

PMID: 18569833 DOI: 10.1080/01676830802009754

We were presented with a teenage female who developed superior ophthalmic vein thrombosis and cavernous sinus thrombophlebitis after a 1-week history of a single acne-like lesion or furuncle at the anterior tip of the nose. She was managed aggressively with heparin and intravenous antibiotic. Signs and symptoms improved after 2 weeks of treatment, and she was discharged with an anticoagulant.

Matched MeSH terms: Cavernous Sinus Thrombosis/drug therapy; Cavernous Sinus Thrombosis/etiology*; Cavernous Sinus Thrombosis/radiography

Fulltext Cavernous sinus hemangioma presenting with binocular diplopia

Lathalakshmi, T., Tai, Evelyn L.M., Qi, Zhe Ngoo, See, Khim Sim, Wan-Hazabbah Wan Hitam, Liza-Sharmini A.T.

Journal of Biomedical and Clinical Sciences, 2017;2(2):32-34.

MyJurnal

A hemangioma is a benign vascular tumor of the brain, which rarely occurs in the cavernous sinus. We report a rare case of cavernous sinus hemangioma presenting with binocular diplopia. A 23-year-old lady presented with binocular diplopia associated with restricted left lateral gaze for 3 months. Visual acuity of both eyes was 6/6 with normal pupillary reaction. Both anterior and posterior segment were unremarkable. Contrasted computed tomography of brain showed an irregular mass within the left cavernous sinus causing pressure effect on the adjacent bone. Cerebral magnetic resonance imaging (MRI) showed a convexity in the left cavernous sinus, with a well-defined heterogeneous lesion with mixed hypo and hyperintensity in T1WI and T2WI; post gadolinium contrast, it was minimally enhanced. The patient was managed conservatively and at one-year post presentation, her symptoms improved but the lesion morphology and size remained static. We highlight the classic radiological presentation of a hemangioma and discuss the features differentiating it from the more commonly observed meningioma seen in the cavernous sinus.

Matched MeSH terms: Cavernous Sinus

Fulltext Endoscopic transnasal approach to anterior and middle cranial base lesions

Tan SH, Brand Y, Prepageran N, Waran V

Neurol India, 2015 Sep-Oct;63(5):673-80.

PMID: 26448224 DOI: 10.4103/0028-3886.166539

We present our experience in managing pathologies involving the anterior and middle cranial base using an endoscopic transnasal approach, highlighting the surgical technique, indications, and complications. The different types of endoscopic approaches used include the transtuberculum/transplanum, transcribiform, transsellar, and cavernous sinus approaches. The common indications include repair of cerebrospinal fluid leaks (both spontaneous and post traumatic) and excision of pituitary adenomas, meningiomas, craniopharyngiomas, esthesioneuroblastomas, and other malignancies of the anterior cranial base. Careful reconstruction is performed with the multilayer technique utilizing fat, fascia lata, and fibrin sealant. The endoscopic transnasal approach, coupled with the present-day sophisticated neuronavigation systems, allows access to lesions in the midline extending from the cribriform plate to the craniovertebral junction. However, preoperative planning and careful selection of cases with evaluation of each case on an individual basis with regard to the lateral extension of the lesion are imperative.

Matched MeSH terms: Cavernous Sinus

Fulltext Diplopia in a post-splenectomy Thalassemic patient

Neoh, Pei Fang, Tai, Evelyn L.M., Liza Sharmini A.T.

Journal of Biomedical and Clinical Sciences, 2017;2(2):26-28.

MyJurnal

We report a case of cavernous sinus thrombosis in a post-splenectomy male with underlying Haemoglobin E Thalassemia major. A 35-year-old man presented with a first episode of sudden onset of diplopia on lateral gaze for 1 week. He had no other ocular and systemic symptoms. There was no history of trauma or recent infection. However, he admitted that he was not compliant to his oral penicillin V and aspirin, which was prescribed to all post splenectomy patients. Unaided visual acuity in both eyes was 6/6. On examination, there was limited abduction over the left eye, suggestive of left lateral rectus palsy. Full blood count revealed leucocytosis with thrombocytosis. Magnetic resonance imaging, magnetic resonance angiography and magnetic resonance venography of the brain showed bulging of the left cavernous sinus, with a persistent focal filling defect, in keeping with left cavernous sinus thrombosis (CST). He was diagnosed with left isolated sixth nerve palsy secondary to aseptic cavernous sinus thrombosis with pro-thrombotic state post-splenectomy. He was started on subcutaneous fondaparinux and oral warfarin. His diplopia fully resolved after 1 month of treatment with complete resolution of CST on computed tomography venogram.

Matched MeSH terms: Cavernous Sinus Thrombosis

A Case of Paraganglioma with Cyanotic Congenital Heart Disease

Wahab NA, Chien BH, Omar MR, Aziz AA, Mustafa N, Sukor N, et al.

Acta Med Indones, 2021 Jan;53(1):77-81.

PMID: 33818409

Co-occurrence of cyanotic congenital heart disease (CCHD) and phaeochromocytoma (PCC) and paraganglioma (PGL) are rare, although some cases have been reported. We report a case of left paraganglioma in a 20-year-old lady with an underlying CCHD who underwent palliative Glenn shunt, subsequently developed polycythaemia and cavernous sinus thrombosis presented with palpitation, sweating, headache and hypertension of 3-months duration at the age of 17. The abdominal CT scan revealed an enhancing left paraaortic mass measuring 5.2 cm x 4.4 cm x 3.8 cm. A 24-hour urine catecholamine demonstrated raised noradrenaline level to six times upper limit of normal and hence diagnosis of left sympathetic (sPGL) was made. In view of the delayed diagnosis and significant morbidity associated with her condition, surgical treatment is no longer an option. Therefore, vigilant screening and early treatment of PCC-PGL in patients with CCHD are crucial in order to avoid significant morbidity and ensure a good quality of life.

Matched MeSH terms: Cavernous Sinus Thrombosis

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