Department of Emergency Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.
Department of Radiology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.
Am J Emerg Med. 2019 Feb;37(2):378.e7-378.e9. doi: 10.1016/j.ajem.2018.11.008. Epub 2018 Nov 7.
A ruptured cavernous carotid aneurysm (CCA) with carotid cavernous fistula can appear as a benign headache but progress to a swollen and bloodshot eye overnight. A 66-year-old woman visited emergency department with sudden onset of pain behind her left forehead and vomiting. She was treated for a migraine-like headache and discharged. She presented again on the next day with a persistent headache and a swollen left eye with blurred vision. An ophthalmologic examination revealed erythema of the left lid and chemosis at the temporal and lower bulbar conjunctiva. A cranial nonenhanced computed tomography (CT) scan had been performed at her previous visit. The scan exhibited a nodular mass lesion involving the left cavernous sinus. CT angiography was subsequently used to determine that the lesion was a giant aneurysm in the left cavernous internal carotid artery, causing enlargement of the left ophthalmic veins. The symptoms of her left eye rapidly progressed to severe chemosis, edematous change over periocular region, and limited movements after 8 h. The patient received emergent lateral canthotomy and inferior cantholysis to avoid acute orbital compartment syndrome and was subsequently treated with stent-assisted coil embolization. A ruptured CCA is an urgent condition that requires rapid assessment of both cranial vascular and ocular lesions. A history of sudden onset headache with a nonpainful acute unilateral red eye may serve as a clue to prompt additional diagnostic studies and ophthalmologist evaluation. Adequate radiological studies and early endovascular intervention can reduce the likelihood of permanent ocular injury and vision impairment.
破裂的海绵窦颈动脉动脉瘤（CCA）伴颈动脉海绵窦瘘可表现为良性头痛，但可在一夜之间发展为眼部肿胀和充血。一位 66 岁女性因左额后突发疼痛和呕吐就诊急诊。她被诊断为偏头痛样头痛并出院。第二天她再次出现持续性头痛和左眼肿胀伴视力模糊。眼科检查显示左眼上睑红斑和颞部及下球结膜水肿。她之前的就诊时已进行了颅脑非增强 CT（CT）扫描。扫描显示左海绵窦内有结节状肿块病变。随后进行 CT 血管造影以确定病变是左海绵窦内颈动脉的巨大动脉瘤，导致左眼静脉扩张。她左眼的症状迅速进展为严重的球结膜水肿、眶周区域水肿性改变和运动受限，在 8 小时后。患者接受紧急外侧眦切开术和下眦切开术以避免急性眶隔综合征，随后接受支架辅助线圈栓塞治疗。破裂的 CCA 是一种紧急情况，需要迅速评估颅脑血管和眼部病变。突发头痛伴有无痛性急性单侧红眼的病史可能提示需要进一步进行诊断性研究和眼科评估。充分的影像学研究和早期血管内介入治疗可以降低永久性眼部损伤和视力损害的可能性。
