[Central vein occlusion as a sequela of spontaneous arteriovenous fistula of the carotid artery to the cavernous sinus].

Abstract

We found a central retinal vein occlusion in three of nine patients with spontaneous arteriovenous fistulas of the cavernous sinus region. The femoral angiogram displayed a "low-flow" fistula from the internal carotid artery and/or dural branches of the external carotid artery into the cavernous sinus in all three patients. Angiographically, occlusion of the superior ophthalmic vein was present in all three patients. The arteriovenous flow of the shunt was directed into the sphenoparietal sinus and into other cerebral veins, but not into the orbit. This is the first angiographic demonstration of occlusion of the superior ophthalmic vein in patients with central retinal vein occlusion. The decrease in blood flow in the superior ophthalmic vein and the central retinal vein occlusion developed several months after the onset of the cavernous fistula. The occurrence of thrombosis is regarded as the consequence of venous stasis in the superior ophthalmic vein. It is assumed that the thrombosis grew retrogradely along the superior ophthalmic vein towards the central retinal vein. The intraocular pressure was not elevated in two of the three patients and therefore not regarded as the cause of the central retinal vein occlusion. Lid erythema and conjunctival hyperemia were pronounced in the acute stage of the fistula formation.