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Ear Trauma
Published in R James A England, Eamon Shamil, Rajeev Mathew, Manohar Bance, Pavol Surda, Jemy Jose, Omar Hilmi, Adam J Donne, Scott-Brown's Essential Otorhinolaryngology, 2022
The risk of vascular injury is higher in more severe skull base fractures, particularly if there is evidence of otic capsule fracture or cranial nerve palsies. Carotid injury may occur at the junction of the lacerum and cavernous portions or more rarely through the petrous segment. Carotid artery dissection with a carotid–cavernous fistula is a rare consequence as is intimal damage resulting in aseptic sigmoid sinus thrombosis. The jugular and carotid canals should be routinely examined on the CT scan with a low threshold for requesting angiography. A specialist neurosurgical opinion should be sought. Treatment is usually endovascular with a variety of options including detachable balloons, coils and stents.
Cranial Neuropathies I, V, and VII–XII
Published in Philip B. Gorelick, Fernando D. Testai, Graeme J. Hankey, Joanna M. Wardlaw, Hankey's Clinical Neurology, 2020
Cavernous sinus (V1, V2)/superior orbital fissure (V1): Aneurysm of carotid siphon or ophthalmic artery.Carotid–cavernous fistula.Cavernous sinus thrombosis.Sarcoidosis.Tolosa–Hunt syndrome: a rare condition that manifests as subacute onset of severe unilateral orbital pain which may be accompanied by a sensory disturbance in V1 and sometimes V2 distribution, and ocular motor (III, IV, and VI cranial) nerve palsies. It is caused by a chronic inflammation behind and/or within the orbit.Infectious etiologies.Tumors (Figure 21.7).
Ophthalmology
Published in Fazal-I-Akbar Danish, Essential Lists of Differential Diagnoses for MRCP with diagnostic hints, 2017
Proptosis (forward protrusion of the eye + lids):1 Ophthalmic Graves’ disease ± thyrotoxicosis (commonest cause of both unilateral and bilateral proptosis).2 Orbital cellulitis (usually an extension from frontal or ethmoidal sinusitis). It is a medical emergency.3 Orbital tumour (rarely primary; often secondary, especially reticulosis).4 Orbital haematoma (usually secondary to head injury).5 Vascular problem (caroticocavernous fistula).
Viral Kerato-Uveitis with Choroidal Vitiligo
Published in Ocular Immunology and Inflammation, 2021
Ankush Kawali, Padmamalini Mahendradas, Srinivasan Sanjay, Rohit Shetty
One-eyed 54-year-old Asian Indian lady, known case of right HZO with corneal involvement, treated elsewhere 4 months prior, presented with the recurrence of kerato-uveitis in OD. The patient also had a history of left sided carotico-cavernous fistula embolization done 2 years ago. Examination revealed stromal keratitis, granulomatous KPs, 1+ cells in anterior chamber, posterior synechiae, clear vitreous, and MHCL in OD (Figure 3Figure 3a,Figure 3b). Other eye examination revealed optic atrophy. Indocyanine green angiography was normal except for few pigment epithelial detachments (PEDs) (Figure 3c). OCT scan confirmed PEDs and ruled out choroidal lesions (Figure 3d). Patient was treated vide supra and the inflammation resolved. Patient had another relapse with dendritic ulcers after 5 months due to inadvertent use of topical cyclosporine. Fundus lesions remained status quo without any evidence of vitritis and other eye examination revealed no evidence of MHCL (Figure 3Figure 3e). Dermal vitiligo post HZO was evident on patient’s right forehead(Figure 3f). Follow-up after detection of MHCL and the total follow-up was 8 months.
Deflation of a Rathke cleft cyst triggered rupture of a superior hypophyseal artery aneurysm: a case report
Published in British Journal of Neurosurgery, 2019
Ryuheki Kitai, Takahiro Yamauchi, Yoshikazu Arai, Tetsuya Hosoda, Norichika Hashimoto, Kenzo Tsunetoshi, Yoshifumi Higashino, Ken-Ichiro Kikuta
A Rathke cleft cyst (RCC) is a benign cystic lesion, exhibiting visual impairment, endocrine deficiencies, and headache require surgery.1 These symptoms result from a mass effect or repeated inflammation due to leakage of the mucus contents of the cyst. Transsphenoidal surgery (TSS) is safe and widely performed.1 However, the most serious complications are cerebrovascular complications such as iatrogenic carotid—cavernous fistula and pseudoaneurysm formation in the internal carotid artery.2,3 These complications are caused by direct injury to the intracavernous portion of the internal carotid artery. We herein report the first case of a ruptured superior hypophyseal artery aneurysm triggered by the rapid deflation of an RCC after TSS.
Optical Coherence Tomography Characterization of Macular Changes Secondary to Arteriovenous Fistula
Published in Neuro-Ophthalmology, 2018
Isabel Pascual-Camps, Clara Martínez-Rubio, Roberto Gallego-Pinazo, Enrique España-Gregori
A 61-year-old man presented with diplopia of 48 hours of evolution and bilateral eyelid oedema and eye redness. Visual acuity (VA) was 20/20 in both eyes. Slit-lamp examination revealed engorged episcleral vessels and diffuse chemosis of both eyes. Applanation IOP was 28 mm Hg in his right eye and 16 mm Hg in his left eye. Dilated fundus examination was unremarkable. Subtle palsy of the VI right cranial nerve could be observed. Right carotid-cavernous fistula was diagnosed through magnetic resonance imaging. Two months later, VA decreased to 20/40 in his right eye and 20/60 in his left eye. Increased vessel engorgement and VI right cranial nerve paralysis was evidenced. Multifocal neurosensory detachment of the retina was observed with vascular tortuosity in both eyes (Figure 1). Optical coherence tomography (OCT) scans revealed multiple neurosensory detachments, retinal pigment epithelium (RPE) irregularity, and irregular and thickened choroid. This condition, both the macular alterations and the AVF, spontaneously regressed, leading to 20/20 VA in both eyes and normal macular OCT after 3 months (Figure 2). Complete follow-up was 1-year.