No toda inflamación orbital es celulitis: un caso clínico de una fístula carotídeo-cavernosa

Introduction

A carotid-cavernous fistula is an abnormal connection between a branch of the carotid artery and the cavernous sinus that can result in severe ocular complications. Ophthalmic signs and symptoms of carotid-cavernous fistula are unspecific, thus difficulties in diagnosis may arise since it can initially be misidentified as primary orbital pathology.

Clinical case

A healthy 39-year-old male who developed diplopia, ipsilateral lacrimation and a pulsating left hemi-cranial headache. Periorbital inflammatory changes, diplopia, and painful ophthalmoplegia without alteration of visual acuity. A thorough diagnostic and imaging process where infectious and non-infectious diseases were investigated, finally identifying a carotid-cavernous fistula. The patient underwent endovascular transarterial embolization, for correction of the carotid-cavernous fistula. He achieved complete recovery of ocular mobility, with edema and pain resolution.

Conclusions

Carotid-cavernous fistula is an entity with multiple forms of presentation, and a high clinical suspicion is necessary for its diagnosis. Timely diagnosis and appropriate treatment can lead to complete recovery and prevent serious complications.