高度怀疑：诊断颈动脉海绵窦瘘。
High index of suspicion: diagnosing a carotid-cavernous fistula.
机构信息
Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA.
Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA
出版信息
BMJ Case Rep. 2023 Mar 2;16(3):e253473. doi: 10.1136/bcr-2022-253473.
A woman in her 70s presented with acute bilateral retro-orbital headache, diplopia, chemosis and eye swelling. Ophthalmology and neurology were consulted after detailed physical examination and diagnostic workup including laboratory analysis, imaging and lumbar puncture. The patient was diagnosed with non-specific orbital inflammation and was started on methylprednisolone and dorzolamide-timolol for intraocular hypertension. The patient's condition improved slightly, but a week later, she developed subconjunctival haemorrhage in the right eye, which prompted investigation for a low-flow carotid-cavernous fistula. Digital subtraction angiography showed bilateral indirect carotid-cavernous fistula (Barrow type D). The patient underwent bilateral carotid-cavernous fistula embolisation. Her swelling improved considerably on day 1 after the procedure and her diplopia improved over the following weeks.
一位 70 多岁的女性患者出现急性双侧眼眶后头痛、复视、球结膜水肿和眼部肿胀。经过详细的体格检查和诊断性检查，包括实验室分析、影像学检查和腰椎穿刺，患者被转至眼科和神经科就诊。该患者被诊断为非特异性眼眶炎症，并开始接受甲泼尼龙和多佐胺-噻吗洛尔治疗眼内压升高。患者的病情略有改善，但一周后，她的右眼出现球结膜下出血，这促使我们对低流量颈动脉海绵窦瘘进行了检查。数字减影血管造影显示双侧间接颈动脉海绵窦瘘（Barrow 分型 D）。患者接受了双侧颈动脉海绵窦瘘栓塞治疗。术后第 1 天，她的肿胀明显改善，数周后复视也得到改善。
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