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• Vol.46 No.4
• CLINICA NEUROL, 46: 261−265, 2006
• Vol.46 No.4 contents

Case Report

Venous infarction associated with carotid-cavernous fistula

Sachiko Ohshima, M.D.¹⁾, Hiroshi Shigeto, M.D.¹⁾, Masakazu Kawajiri, M.D.¹⁾, Takayuki Taniwaki, M.D. ¹⁾, Kei Yoshiura, M.D.²⁾ and Jun-ichi Kira, M.D.¹⁾

¹⁾Department of Neurology, Neurological Institute, Graduate School of Medical Sciences, Kyushu University
²⁾Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University

We report an 88-year-old woman who developed a hemorrhagic venous infarction in the left cerebral hemisphere and brainstem, in association with left carotid-cavernous fistula (CCF). Without aura the patient noticed diplopia due to left abducens palsy, and exophthal mos and congestion of the left eye. Brain CT revealed extrusion of the left eye, and dilatation of left superior orbital vein and cerebral cortical veins. She received diagnosis of CCF. Brain CT also revealed a small mass in the left ethmoidal sinus, which was not attached to the CCF. Biopsy of the mass was done under local anesthesia. On the following she had high fever. Her consciousness level deteriorated and she developed right hemiparesis FLAIR images of MRI showed, extensive high signal lesions in the left frontal and temporal cortices, basal ganglia, thalamus, midbrain and pons. These findings were consisted with venous infarction, possibly associated with peri-operative infection and hypovolemia. Intracranial hemorrhage occur in 3% of cases with CCF, but venous infarction was much rarer. The patients with CCF, who show dilatation of cortical veins in CT or MRI, have a higher risk of cerebral hemorrhage or infarction, and should be carefully observed.

(CLINICA NEUROL, 46: 261−265, 2006)
key words: carotid-cavernous fistula, cerebral infarction, venous infarction, brainstem infarction, cortical vein

(Received: 12-Apr-05)