Delayed Onset Central Retinal Vein Occlusion (CRVO) in Traumatic Carotid Cavernous Sinus Fistula (CCSF)-A Case Report

外傷性頸動脈海綿竇瘻管導致遲延性中心性視網膜靜脈阻塞－病例報告

陳慶隆(Ching-Lung Chen) ； 蔡元雄(Yuan-Hsiung Tsai) ； 吳佩蓁(Pey-Jane Wu) ； 周宗賢(Tsung-Hsien Chou) ； 賴建雄(Chien-Hsiung Lai)

《中華民國眼科醫學會雜誌》 47卷3期 (2008/09) Pp. 235-240

https://doi.org/10.30048/ACTASOS.200809.0006

摘要

目的：報告一例未曾接受治療之外傷性頸動脈海綿竇屢管患者，發生遲延性中心性視網膜靜脈阻塞，在眼底攝影，電腦斷層血管攝影，腦血管攝影，及光學同調電腦斷層上的表現。
方法：病例報告。
結果：一名56歲男子於跌落頭部左側外傷發生左眼腫脹及異音，但於數週後痊癒且無明顯眼部不適。於受傷後約2個月發生視力逐漸模糊，雙眼複視。4個月後，因眼球外凸，前來就醫。眼科檢查發現眼球前凸，結膜血管擴大扭曲，左外側轉局限，視網膜出血，靜脈擴大扭曲，及棉狀滲出物，最佳矯正視力僅20/70。沒有眼壓增加及視神經傳導異常。經血管攝影發現動脈期上眼靜脈及海綿竇擴大，屬於直接型。建議接受血管內栓塞治療，但患者因須再考慮及健保與經濟上考量而出院。
結論：因外傷性頸動脈海綿竇瘻管所致之非缺血性中心性視網膜靜脈阻塞的似乎擁有較好視力癒後，早期發現及治療可能預防中心性視網膜靜脈阻塞及視力受損。

並列摘要

Purpose: To report a patient suffering from untreated traumatic carotid cavernous sinus fistula (CCSF), followed by delayed onset central retinal vein occlusion (CRVO) and presentation on color fundus images, computer tomography angiography (CTA) and cerebral angiography, optical coherence tomography (OCT).
Method: Case report.
Result: We present the case of a patient who suffered from a blunt head injury resulting in a delayed diagnosis of a carotid-cavernous sinus fistula and subsequent central retinal vein occlusion (CRVO). A 56-year-old male patient presented as progressively blurred vision of the left eye and diplopia for about 2 months after falling from a tree 6 months ago. The symptom of persistent bruit and mild left orbital distention was noted 1-2 days after trauma, but subsided later. Unable to tolerate blurred vision and bruit disturbance that had persisted for several months, the patient sought medical help. Left eyeball protrusion with bulbar conjunctival vessels engorged, lateral gaze limitation of the left eye, and extensive retinal hemorrhages and dilated tortuous veins with cotton wool spots in fundus, and best corrected visual acuity 20/70 were noted. There is no elevated intraocular pressure and absence of relative afferent pupillary defect. Enlarged left superior ophthalmic vein and left cavernous sinus were identified on both CTA and conventional cerebral angiography that is compatible with direct carotid cavernous fistula. OCT revealed mild macular edema (237um). An endovascular embolization was advised, but the patient asked to be discharged due to more time needed for considering the insurance coverage and arranging for claims.
Conclusion: Patient with CRVO induced by traumatic CCSF seems to have better visual acuity outcome in this case report. Early medical consultation or CCSF detection may prevent subsequent complications including CRVO and visual deterioration.

並列關鍵字

Carotid cavernous sinus fistula ； Central retinal vein occlusion ； Cerabral angiography ； Computer tomography angiography