From the Department of Neurology, Miller School of Medicine, University of Miami, FL.
Neurology. 2014 Jul 8;83(2):e18. doi: 10.1212/WNL.0000000000000562.
A 45-year-old man presented with a painful bulging right eye and blindness 6 weeks after a motorcycle accident and traumatic brain injury. He had a complete right oculomotor nerve palsy and only perception of light. MRI revealed ipsilateral pontomesencephalic edema (figure, A and B). Catheter angiography showed a direct right carotid-cavernous fistula (figure, C). Two months after coil embolization, the ptosis, proptosis and ophthalmoplegia resolved. MRI revealed resolution of pontomesencephalic edema (figure, D). The presumed mechanism was transmission of arterialized pressures of the cavernous sinus via a bridging vein to the anterior pontomesencephalic vein, generating venous hypertension and vasogenic edema.
一位 45 岁男性，在摩托车事故和外伤性脑损伤后 6 周出现右眼疼痛性突出和失明。他出现完全性右侧动眼神经麻痹，仅能感知光。MRI 显示同侧桥脑被盖水肿（图 A 和 B）。导管血管造影显示右侧颈动脉-海绵窦直接瘘（图 C）。线圈栓塞治疗 2 个月后，上睑下垂、眼球突出和眼肌麻痹均得到缓解。MRI 显示桥脑被盖水肿消退（图 D）。推测的发病机制是通过桥前吻合静脉将海绵窦动脉化压力传递到前桥脑正中静脉，导致静脉高压和血管源性水肿。
