Loré Fausto, Polito Ennio, Cerase Alfonso, Bracco Sandra, Loffredo Antonio, Pichierri Patrizia, Talidis Filotas
Department of Internal Medicine, Endocrinology, and Metabolism, University of Siena, Italy.
J Clin Endocrinol Metab. 2003 Aug;88(8):3487-90. doi: 10.1210/jc.2003-030272.
The clinical manifestations of carotid cavernous fistula, an abnormal arteriovenous connection between the cavernous sinus and the carotid artery, can closely mimic the cardinal signs of Graves' ophthalmopathy, an inflammatory disorder of the orbit usually associated with autoimmune thyroid disease. Therefore, carotid cavernous fistulas are generally considered in the differential diagnosis of Graves' ophthalmopathy, especially when the eye involvement is unilateral or asymmetric, and there is the need for exclusion of rarer etiologies of orbital disease. This is the first report of the simultaneous occurrence of Graves' ophthalmopathy and carotid cavernous fistula. The patient was a 67-yr-old woman who presented with a history of Graves' disease with mild bilateral ophthalmopathy treated with radioiodine following a 10-yr therapy with methimazole; after radioiodine treatment, ophthalmopathy deteriorated. At the time of our initial clinical evaluation the ocular involvement of the patient was symmetric, and no evidence of any associated condition was found. However, the response of eye disease to corticosteroid treatment was markedly unequal, resulting in evident asymmetry. This prompted a reconsideration of the diagnosis and a new evaluation of the patient with sensitive techniques, leading to the further diagnosis of carotid cavernous fistula.
海绵窦瘘是海绵窦与颈动脉之间的一种异常动静脉连接，其临床表现可能与格雷夫斯眼病的主要体征极为相似。格雷夫斯眼病是一种眼眶炎性疾病，通常与自身免疫性甲状腺疾病相关。因此，在格雷夫斯眼病的鉴别诊断中通常会考虑海绵窦瘘，尤其是当眼部受累为单侧或不对称时，且需要排除眼眶疾病的罕见病因。这是关于格雷夫斯眼病与海绵窦瘘同时发生的首例报告。该患者为一名67岁女性，有格雷夫斯病病史，曾接受甲巯咪唑治疗10年，后行放射性碘治疗，伴有轻度双侧眼病；放射性碘治疗后，眼病恶化。在我们最初的临床评估时，患者的眼部受累是对称的，未发现任何相关疾病的证据。然而，眼部疾病对皮质类固醇治疗的反应明显不均衡，导致明显的不对称。这促使重新考虑诊断，并采用敏感技术对患者进行重新评估，进而诊断出海绵窦瘘。
