Pickel Lauren, Micieli Jonathan A
aFaculty of Medicine, University of Toronto, Toronto, Ontario, Canada.
bDepartment of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada.
Case Rep Ophthalmol. 2022 Sep 30;13(3):700-705. doi: 10.1159/000526566. eCollection 2022 Sep-Dec.
An indirect carotid cavernous fistula (CCF) is an abnormal connection between the cavernous sinus and internal or external carotid artery. Indirect CCFs often occur spontaneously, particularly in the setting of vascular risk factors such as hypertension, diabetes, and atherosclerosis. Microvascular ischemic nerve palsies (NPs) share these vascular risk factors. However, to date, no temporal relationship between microvascular ischemic NP and indirect CCF occurring sequentially has been reported. We describe the cases of 64- and 73-year-old women who developed indirect CCFs within 1-2 weeks after spontaneous resolution of a microvascular ischemic 4th NP. Both patients had complete resolution and an asymptomatic period between the 4th NP and CCF. This case highlights the shared pathophysiology and risk factors between microvascular ischemic NPs and CCFs, and emphasizes that CCFs should be kept in the differential diagnosis for red eye or recurrent diplopia in patients with previous microvascular ischemic NP.
间接型颈内动脉海绵窦瘘（CCF）是海绵窦与颈内动脉或颈外动脉之间的异常连接。间接型CCF常自发发生，尤其是在存在高血压、糖尿病和动脉粥样硬化等血管危险因素的情况下。微血管缺血性神经麻痹（NPs）也有这些血管危险因素。然而，迄今为止，尚未有关于微血管缺血性NP与间接型CCF相继发生的时间关系的报道。我们描述了两名女性患者的病例，分别为64岁和73岁，她们在微血管缺血性动眼神经麻痹自发缓解后的1 - 2周内发生了间接型CCF。两名患者的动眼神经麻痹均完全缓解，且在动眼神经麻痹与CCF之间有一段无症状期。该病例突出了微血管缺血性NPs与CCF之间共同的病理生理学和危险因素，并强调对于既往有微血管缺血性NP的患者，出现红眼或复发性复视时，CCF应列入鉴别诊断范围。
