Spontaneous Carotid-Cavernous Fistula and Subarachnoid Hemorrhage

Background: The carotid-cavernous fistula (CCF) is a communication between the internal carotid artery and the cavernous sinus vein. This is a rare condition. It is often described in trauma but the CCF can be spontaneous. CCF can be direct in traumatic condition (direct communication between intracavernous carotid artery and the cavernous sinus vein) or indirect. Objective: We report a case of CCF. Case Report: A 43-year-old lady, right-handed, single, and mother of two children was admitted in emergency neurology for intense headaches with vomiting, two generalized seizures, and a sudden onset of consciousness disorders on April 19, 2016. Symptoms began 2 hours before her admission. She had no vascular history. The physical examination revealed intense headaches. The blood pressure was 130/80 mm Hg with normal temperature (36.8°C). There was a light comas status with a Glasgow score of 12/15, a stiff neck, left hemiparesis and a bilateral Babinski reflex, right ptosis associated with reactive mydriasis, an exophthalmos, and a total right ophthalmoplegia. Ophthalmologic examination revealed a right visual acuity of 1/10 with macular chorioretinitis. The brain CT scan displayed a dilatation and hyperdensity of right cavernous sinus with dilatation of the right ophthalmic vein associated with a subarachnoid hemorrhage. The routine biological tests were normal. An analgesic treatment had been administered in addition to nimodipine and mannitol (against brain edema) and clonasepam (against seizures). Unfortunately, as interventional neuroradiology and arteriography are not available, the patient had died on the seventh day of hospitalization in a context of increased intracranial hypertension. Conclusion: In developing countries, the management of CCF is very difficult because of the lack of interventional neuroradiological platform. Arteriography is appropriate for diagnosis and endovascular treatment. Publication History Article published online: 14 December 2021 © 2021. The Pan Arab Interventional Radiology Society. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/) Thieme Medical and Scientific Publishers Pvt. Ltd. A-12, 2nd Floor, Sector 2, Noida-201301 UP, India