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The cardiovascular system
Published in C. Simon Herrington, Muir's Textbook of Pathology, 2020
Mary N Sheppard, C. Simon Herrington
The finding post mortem of an aneurysmal dilatation of a long segment of one or more coronary arteries needs careful consideration of a number of causes. Localized aneurysms are mainly atherosclerotic in elderly individuals, but may also be congenital, or occur as a result of Kawasaki's disease (see Special Study Topic 7.1) or trauma. Traumatic penetration may cause a false aneurysm, which is the fibrous wall of an organized haematoma communicating with the arterial lumen. Trauma to adjacent arteries and veins may lead to an arteriovenous fistula. A carotid–cavernous sinus fistula may follow a skull fracture. Proptosis is due to venous engorgement and orbital oedema. A cirsoid or racemose aneurysm is an arteriovenous fistula that forms a pulsatile swelling, comprising tortuous and dilated arteries and veins with multiple intercommunications. It is most common in the scalp after birth injury or other trauma.
Double Vision and New Onset Strabismus in an Adult
Published in Amy-lee Shirodkar, Gwyn Samuel Williams, Bushra Thajudeen, Practical Emergency Ophthalmology Handbook, 2019
Perform related examinations to help locate the problem, for example an orbital exam, including exophthalmometry for orbital apex pathology, or listening for a bruit for carotid cavernous sinus fistula. This is almost never detected properly by an ophthalmologist but comes up in exams.
Orbital Fractures
Published in Jeffrey R. Marcus, Detlev Erdmann, Eduardo D. Rodriguez, Essentials of CRANIOMAXILLOFACIAL TRAUMA, 2014
Regina M. Fearmonti, Jeffrey R. Marcus
Operative exploration is indicated for increased intraocular pressure and presence of an acute space-occupying lesion, which can compromise neurovascular structures and lead to vision loss within 1 hour of onset. The classic presentation of retrobulbar hematoma includes proptosis, pain, and CN III palsy with a progressive decrease in visual acuity. Emergent decompression is indicated with findings of a tense, proptotic globe. Access is obtained through a transcutaneous, transseptal incision (Fig. 14-3). A transconjunctival pressure release—with or without a lateral canthotomy—is performed, followed by an inferior cantholysis. The presence of an associated carotid-cavernous sinus fistula, presenting as a pulsating exophthalmos, can be ruled out with imaging.
Superior ophthalmic vein thrombosis post manual carotid compression for indirect carotid-cavernous fistula
Published in Orbit, 2021
Shebin Salim, Kirthi Koka, Swatee Halbe, Sonam Poonam Nisar, Parinita Singh, Bipasha Mukherjee
A carotid-cavernous sinus fistula (CCF) is an abnormal communication between the carotid artery or its branches and the cavernous sinus. (Figures 1a–c and 2b) IMCC is a non-invasive and cost-effective method for the treatment of indirect CCF.3 It is done by compressing the carotid artery – jugular vein complex in the neck with the contralateral hand for 30 seconds, until the pulsations are no longer palpable, followed by relaxation for 30 seconds. This is initially done 5 times an hour preferably in a supine or sitting position. Later, the duration and frequency are gradually increased to a maximum of 10 to 15 times an hour. IMCC acts by temporarily equalizing the pressure on either end of the fistula, resulting in stasis and thrombosis within the cavernous sinus or its smaller tributaries, leading to spontaneous closure of an indirect CCF.4 IMCC is thus not recommended in patients with posterior drainage into the cortical venous system or progressive visual decline at initial presentation.3Venous thrombosis of the cavernous sinus or its tributaries can be considered as the initiating event in the spontaneous closure of an indirect CCF and should be anticipated in patients being treated with IMCC.3,4
Acute Onset Variable and Progressive Trochlear Nerve Palsy and Ophthalmoparesis Secondary to Bilateral Carotid Cavernous Fistula
Published in Journal of Binocular Vision and Ocular Motility, 2021
Lucas Bonafede, Anant Patel, Mays El-Dairi, Daniel J. Ozzello, Federico G. Velez
A CTA of the head was obtained which was non-diagnostic due to bolus timing. There was enlargement of extraocular muscles without dilatation of left SOV to suggest a CCF. Follow-up 1 week later revealed 2 mm of left proptosis and an otherwise stable exam. Due to continued concerns for CCF, a repeat CTA was performed and revealed greater than expected contrast opacification of left greater than right cavernous sinuses without SOV dilation (Figure 3a–c). Catheter angiography revealed a posterior-draining indirect CCF of the right internal carotid artery (ICA) and an anterior-draining indirect CCF of the left ICA (Figure 4b). Coil embolization of bilateral Carotid cavernous sinus fistula via transvenous approach resulted in immediate resolution of diplopia, headaches, and congestive symptoms following the procedure. At a 3-week post-operative follow-up, there was no diplopia, no headaches, vision had improved. Examination revealed improved chemosis and full extraocular movements.
Anterior Segment Applications of Optical Coherence Tomography Angiography
Published in Seminars in Ophthalmology, 2019
Ang, Sng, and Milea performed OCT-A to assess episcleral vasculature in a patient with a dural carotid-cavernous sinus fistula. In this study, OCT-A was used to delineate increased episcleral venous flow, which is currently measured with more invasive techniques with highly variable results. They also imaged the retina in this patient and found focal reduction in peripapillary retinal perfusion, suggesting early glaucomatous optic neuropathy. They concluded that OCT-A may have a role in determining risk of glaucoma in patients with CCF in the future.14