Low-flow carotid-cavernous fistula associated with cavernous sinus thrombosis: An ophthalmic presentation.
M Moro-Muniz, E Sanz Marco, D Salom Alonso
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Case in brief
A 70-year-old woman presented with painless unilateral proptosis and ocular discomfort, without infectious symptoms. Examination showed conjunctival chemosis and hyperemia, elevated intraocular pressure, and mild limitation of eye movements. Imaging demonstrated cavernous sinus thrombosis, superior ophthalmic vein dilation, and findings consistent with a low-flow carotid-cavernous fistula and orbital venous hypertension. Ultrasonography showed reversed arterialized flow in the superior ophthalmic vein. With topical pressure-lowering agents and oral acetazolamide, her symptoms improved; follow-up imaging showed spontaneous resolution of the fistula and venous congestion, with full clinical recovery.
What made this case unusual
The low-flow fistula occurred alongside partial cavernous sinus thrombosis and presented without infectious symptoms; ultrasonography demonstrated reversed arterialized flow in the superior ophthalmic vein.
Diagnostic / clinical pearl
Unilateral proptosis with ocular hypertension and a dilated superior ophthalmic vein can reflect orbital venous hypertension from a low-flow carotid-cavernous fistula, even when cavernous sinus thrombosis is also present.