1. Bojana Markić,
Republic of Srpska, Bosnia and Herzegovina
Aim: Recognize the occurrence of posttraumatic carotid-cavernous fistulas (CCF) on the basis of ophthalmologic symptoms Case study: 50 years old man suffered a head injury.Native CT head revealed multiple fractures of bones at the scull base and sphenoidal and ethmoidal hematosinus, as well as subarachnoid hemorrhage.He has been hospitalized in Neurosurgical clinic for duration of 1,5 months.One month from head injury,he was examined by the ophthalmologist who diagnosed chemosis of the right eye. Due to the difficult general condition of patient,examination with slit lamp is not performed and visual acuity,in the amount of 5/60 is determined on orientation basis.After several days,clinical features of proptosis of the right bulb with total ophthalmoplegia,chemosis,relativ afferent pupillar defect and present of an audible bruit as well as paralysis of n.abducentis on left eye, developed.Control CT scan of head is suggested and showed no significant deviation from previous one. After the completion of treatment in Neurosurgical clinic,patient is examined by ophthalmologist.Due to significant chemosis and subsequent xerosis, blepharoraphia is performed on right eye.After 5 days,the same ophthalmologist symptoms,developed on left eye as well. At that time visual loss of both eyes had appeard.Patient was then hospitalized in Ophthalmology clinic for further treatment and diagnosis.Due to present of conjunctivitis purulenta,swab of conjunctiva was performed,and therapy included antibiotic ointment,in accordance with antibiogram,and lubrificant,in form of drops and gel.Venous stasis retinopathy were visible on both eye with intraretinal hemorrhages on right side. Values of IOP were within 21-24mmHg and antiglaucomatous therapy was included.MR angiography was performed and it showed direct bilateral carotid-cavernous fistulas,which prompted further treatment of patient by intervention neuroradiologist,who performed embolisation of CCF. After few days,clinical examination showed total resolution of ophthalmological signs and symptoms except paralysis of n.abducentis of left eye and diplopija.
Conclusion: After craniocerebral trauma,occurrence of chemosis,proptosis and a bruit over the eye,can be first symptoms which should alarm to development of CCF.Multidisciplinary approach is of great significance in diagnostics and treatment of patients with such problems
Кључне речи :
Тематска област:
neurooftalmologija
Уводни рад:
Да
Датум:
30.03.2012.
Бр. отварања:
636
