Spontaneous intracerebral hematoma from occult carotid-cavernous fistula during pregnancy and puerperium

1992 ◽  
Vol 76 (4) ◽  
pp. 714-717 ◽  
Author(s):  
Tzu-Kang Lin ◽  
Chen-Nen Chang ◽  
Yau-Yau Wai
Keyword(s):  
Clinical Symptoms ◽  
Cerebral Aneurysms ◽  
Subsequent Pregnancy ◽  
Venous Hypertension ◽  
Intracerebral Hematoma ◽  
Carotid Cavernous Fistula ◽  
Back Flow ◽  
Content Type ◽  
Cavernous Fistula ◽  
Partial Thrombosis

✓ In most cases, intracerebral hemorrhage during pregnancy or puerperium results from cerebral aneurysms or arteriovenous malformations. The authors present a case of a 30-year-old woman whose symptoms from a traumatic carotid-cavernous fistula had completely resolved 1½ years after the event, but recurred 4 years later, causing two hemorrhages during pregnancy (33rd and 35th week of gestation) and one during the postpartum period (10 days after Caesarean section). Partial thrombosis of the cavernous sinus with obliteration of most of the drainage from the fistula accounted for the resolution of clinical symptoms, but also promoted back-flow to the preserved drainage of superficial cortical veins. The hemodynamic changes and the hormonal effects due to the patient's subsequent pregnancy further aggravated the venous engorgement and finally caused rupture. All three hematomas occurred in the vicinity of the extremely dilated veins, suggesting that back-flow with venous hypertension was the probable cause for the intracerebral hematomas. Spontaneous healing of the carotid-cavernous fistula should be confirmed with cerebral angiography.

Spontaneous intracerebral hematoma in carotid-cavernous fistula

1983 ◽  
Vol 59 (4) ◽  
pp. 680-686 ◽  
Author(s):  
Donn M. Turner ◽  
John C. Vangilder ◽  
Saeid Mojtahedi ◽  
Eric W. Pierson
Keyword(s):  
Cerebral Angiography ◽  
Intracerebral Hematoma ◽  
Carotid Cavernous Fistula ◽  
Back Flow ◽  
Content Type ◽  
Cavernous Fistula ◽  
Fine Print

✓ Spontaneous intracerebral hematoma associated with carotid-cavernous fistula is rare. Three new cases are presented. In each, the hemorrhage originated in the vicinity of localized intracranial venous engorgement, as demonstrated by cerebral angiography. Rupture of one or several of the distended venous channels from increased back-flow is postulated as the etiology of the intraparenchymal hematomas.

Spontaneous carotid-cavernous fistula during pregnancy or in the postpartum stage

1981 ◽  
Vol 54 (2) ◽  
pp. 252-256 ◽  
Author(s):  
Shigeo Toya ◽  
Ryuzoh Shiobara ◽  
Jiroh Izumi ◽  
Youichi Shinomiya ◽  
Hayao Shiga ◽  
...  
Keyword(s):  
Cerebral Angiography ◽  
Clinical Symptoms ◽  
Carotid Cavernous Fistula ◽  
Normal Delivery ◽  
Content Type ◽  
Cavernous Fistula ◽  
Arteriovenous Fistulas ◽  
Dural Arteriovenous Fistulas ◽  
Spontaneous Improvement ◽  
Angiographic Findings

✓ The authors report two cases of spontaneous carotid-cavernous fistula that occurred during pregnancy. One patient was a 21-year-old woman whose symptoms improved and in whom disappearance of the carotid-cavernous fistula was confirmed by cerebral angiography after she aborted in the 12th week of pregnancy. The other patient was a 25-year-old woman in whom a carotid-cavernous fistula occurred at about the 28th week of pregnancy. The symptoms became aggravated 3 weeks after a normal delivery. Carotid-cavernous fistula was confirmed by cerebral angiography, and the clinical symptoms then improved. On the basis of cerebral angiographic findings, both patients were considered to have dural arteriovenous fistulas in the region of the cavernous sinus and both demonstrated spontaneous improvement.

Electrothrombosis of carotid-cavernous fistula

1975 ◽  
Vol 42 (1) ◽  
pp. 76-85 ◽  
Author(s):  
Yoshio Hosobuchi
Keyword(s):  
Posterior Segment ◽  
Cerebral Vein ◽  
Superior Ophthalmic Vein ◽  
Carotid Cavernous Fistula ◽  
Content Type ◽  
Cavernous Fistula ◽  
Arterial Circulation ◽  
Inferior Portion ◽  
Pterygoid Plexus ◽  
Fine Print

✓ The author describes a technique for directly closing a carotid cavernous fistula with electrothrombosis while preserving the intracranial arterial circulation. Copper wires are introduced through the superior ophthalmic vein or a frontotemporal craniotomy, and thus directly into the portion of the sinus into which the fistula drains; if posterior, into the posterior segment of Parkinson's triangle, if inferior, into the pterygoid plexus, and if anterior, through the sphenoparietal sinus and/or middle cerebral vein to the anterior-inferior portion of the sinus. A direct current is applied until a thrombus is confirmed angiographically and the wires are left in place. Four patients treated by this method are presented.

Venous rupture during transvenous approach to a carotid-cavernous fistula

1989 ◽  
Vol 71 (1) ◽  
pp. 133-137 ◽  
Author(s):  
Wesley A. King ◽  
Grant B. Hieshima ◽  
Neil A. Martin
Keyword(s):  
Carotid Artery ◽  
Cavernous Sinus ◽  
Balloon Occlusion ◽  
Alternative Methods ◽  
Ocular Motility ◽  
Carotid Cavernous Fistula ◽  
Content Type ◽  
Cavernous Fistula ◽  
A Minor ◽  
Transvenous Approach

✓ An attempt at transfemoral transarterial balloon occlusion of a high-flow spontaneous carotid-cavernous fistula was unsuccessful because the carotid artery rent was too small for this approach. During a subsequent transvenous approach to the cavernous sinus through the jugular vein, the inferior petrosal sinus was perforated. A minor subarachnoid hemorrhage occurred before the tear could be sealed by the deposition of three Gianturco coils in the vein. The patient was taken to the operating room for emergency obliteration of the fistula and petrosal sinus in order to remove the risk of further hemorrhage. Under the guidance of intraoperative digital subtraction angiography, isobutyl-2-cyanoacrylate was injected directly into the surgically exposed cavernous sinus. Successful obliteration of the fistula was achieved with preservation of the carotid artery, and the angiography catheter was removed safely from the petrosal sinus. Although initially after surgery the patient had nearly complete ophthalmoplegia, at her 1-year follow-up examination she had normal ocular motility and visual acuity. The transvenous approach to the cavernous sinus and alternative methods of treatment of carotid-cavernous fistulas are discussed.

Experiences with surgical thrombosis of intracranial berry aneurysms and carotid cavernous fistulas

1974 ◽  
Vol 41 (6) ◽  
pp. 657-670 ◽  
Author(s):  
Sean Mullan
Keyword(s):  
Blood Flow ◽  
Intracranial Aneurysm ◽  
Carotid Cavernous Fistula ◽  
Content Type ◽  
Cavernous Fistula ◽  
Carotid Blood Flow ◽  
Giant Intracranial Aneurysm ◽  
Surgical Methods ◽  
Carotid Cavernous Fistulas ◽  
Fine Print

✓ The results of 61 cases of stereotaxic thrombosis of intracranial berry aneurysms indicate that the technique in selected cases is comparable to, but not necessarily superior to standard surgical methods. The results of wire-induced thrombosis in 15 cases of giant intracranial aneurysm suggest that this method is effective in situations where clipping and encapsulation are inapplicable. The results of thrombosis in six cases of carotid cavernous fistula suggest that intracavernous wire thrombosis may prove to be the treatment of choice in that it seals the fistula without impairing carotid blood flow.

Deflation of metrizamide-filled balloon used to occlude a carotid-cavernous fistula

1983 ◽  
Vol 59 (3) ◽  
pp. 524-528 ◽  
Author(s):  
Thomas J. Leipzig ◽  
Sean F. Mullan
Keyword(s):  
Contrast Agent ◽  
Vascular Wall ◽  
Carotid Cavernous Fistula ◽  
Technical Problems ◽  
Content Type ◽  
Cavernous Fistula ◽  
Short Summary ◽  
Carotid Cavernous Fistulas ◽  
Fine Print

✓ A carotid-cavernous fistula was occluded by a detachable latex balloon. Because of technical problems, the contrast-filled balloon was left in a precarious position in the ostium of the fistula. Premature deflation of the balloon would have resulted in intra-arterial migration of the device. Approximately 1 week is required for the balloon to become secured in place by fibrous attachment to the vascular wall. For success, if the ligature is adequate, a detachable Debrun balloon should remain inflated for this period of time. The deflation process was monitored radiographically in this patient. The balloon remained inflated for at least 2 weeks. A short summary of the experience with deflation of various contrast-containing balloon devices in the treatment of carotid-cavernous fistulas is given. Metrizamide may be the best contrast agent for use in these devices.

External carotid-cavernous sinus fistula diagnosed by common carotid arteriography

1974 ◽  
Vol 41 (4) ◽  
pp. 494-498 ◽  
Author(s):  
Louis Wener ◽  
Giovanni Di Chiro ◽  
Robert A. Mendelsohn
Keyword(s):  
Cavernous Sinus ◽  
Carotid Arteries ◽  
External Carotid ◽  
Carotid Cavernous Fistula ◽  
Content Type ◽  
Cavernous Fistula ◽  
Carotid Cavernous Sinus Fistula ◽  
The Difference ◽  
Fine Print

✓ An external carotid-cavernous fistula diagnosed by serial common carotid arteriography is reported. The diagnosis was reached on the basis of the difference in time between filling of the distal internal and external carotid arteries and the visualization of the fistula.

External carotid-cavernous fistula treated by arterial embolization

1974 ◽  
Vol 40 (1) ◽  
pp. 110-114 ◽  
Author(s):  
M. Stephen Mahalley ◽  
Stephan C. Boone
Keyword(s):  
Carotid Artery ◽  
Successful Treatment ◽  
Arterial Embolization ◽  
External Carotid Artery ◽  
External Carotid ◽  
Carotid Cavernous Fistula ◽  
Content Type ◽  
Cavernous Fistula ◽  
Unusual Occurrence ◽  
Fine Print

✓ The unusual occurrence of a carotid-cavernous fistula supplied entirely by branches of the external carotid artery is presented, and its successful treatment by arterial embolization described.

Regional parenchymal enhancement with mixed cavernous/venous malformations of the brain

1997 ◽  
Vol 86 (1) ◽  
pp. 154-158 ◽  
Author(s):  
Christopher H. Comey ◽  
Douglas Kondziolka ◽  
Howard Yonas
Keyword(s):  
Clinical Symptoms ◽  
Vascular Malformations ◽  
Venous Hypertension ◽  
Venous Malformations ◽  
True Nature ◽  
Cavernous Malformations ◽  
Content Type ◽  
Growth Factor Release ◽  
The Brain ◽  
Parenchymal Enhancement

✓ With improvements in imaging technology, the detection of both cavernous malformations and venous malformations has increased markedly in recent years. Although much has been learned about the association of cavernous and venous malformations, important questions regarding the true nature of such a relationship remain unanswered. It has been proposed that certain venous malformations produce local venous hypertension with resultant microhemorrhage, growth factor release, and creation of cavernous malformations. The authors report on two patients with cerebellopontine venous malformations associated with cavernous malformations. Both patients demonstrated persistent regional parenchymal enhancement associated with the vascular malformations. In addition, both patients had significant clinical symptoms referable to the region of affected brain. This previously undescribed finding may represent an imaging correlate to the complex interaction among venous malformations, venous hypertension, and cavernous malformations.

Traumatic carotid—cavernous fistula treated by combined transarterial and transvenous coil embolization and associated cavernous internal carotid artery dissection treated with stent placement

2003 ◽  
Vol 99 (3) ◽  
pp. 584-586 ◽  
Author(s):  
Süleyman Men ◽  
Halil Öztürk ◽  
Baki HekimoğLu ◽  
Zeki Şekerci
Keyword(s):  
Carotid Artery ◽  
Stent Placement ◽  
Coil Embolization ◽  
Motor Vehicle ◽  
Motor Vehicle Accident ◽  
Carotid Artery Dissection ◽  
Artery Dissection ◽  
Carotid Cavernous Fistula ◽  
Content Type ◽  
Cavernous Fistula

✓ The authors report on a case in which a carotid—cavernous fistula and an associated cavernous—carotid dissection developed in a 48-year-old man following a motor vehicle accident. The fistula was treated with coil embolization via a combined transarterial—transvenous approach. The dissected carotid artery segment was treated with a balloon-expandable stent, which restored normal caliber and hemispheric flow. There was no recurrence of the fistula and the postoperative wide patency of the carotid artery indicates that stent placement is an effective method of treating traumatic intracranial artery dissections.

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