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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).
Ear Trauma
Published in John C Watkinson, Raymond W Clarke, Christopher P Aldren, Doris-Eva Bamiou, Raymond W Clarke, Richard M Irving, Haytham Kubba, Shakeel R Saeed, Paediatrics, The Ear, Skull Base, 2018
Fractures of the bony canals of the internal carotid artery and sigmoid venous sinuses are relatively common but publications are sparse and mainly confined to the neurosurgery and neuroradiology literature. Those patients with worse injuries and a lower GCS are more likely to have a fracture involving the carotid canal.201 Only 4% of skull base fractures result in vascular injury despite about a quarter of fractures entering the carotid canal. Sixty-two percent occur at the junction between its lacerum and cavernous portions (the spheno-occipital suture), and about 18% of these sustain a vascular injury. Fractures through the petrous segment are less common but carry a higher, 25%, risk of vascular injury.201 Internal carotid artery dissection with carotid–cavernous fistula is a rare consequence.193 Intimal damage resulting in aseptic sigmoid sinus thrombosis is rare (1 in 82 temporal bone fractures).163
Cranial Neurosurgery
Published in Professor Sir Norman Williams, Professor P. Ronan O’Connell, Professor Andrew W. McCaskie, Bailey & Love's Short Practice of Surgery, 2018
Professor Sir Norman Williams, Professor P. Ronan O’Connell, Professor Andrew W. McCaskie
Dural arteriovenous fistulae (DAVFs) are shunts between dural arteries and veins or sinuses. They are proposed to arise as a result of vessel remodelling in response to dural sinus thrombosis and subsequent recanalisation. They may present with subarachnoid, intracerebral or subdural bleeding, or with headache and pulsatile tinnitus. A carotid cavernous fistula is a spontaneous or traumatic DAVF between the internal carotid artery and surrounding cavernous sinus, typically producing eye pain, ocular muscle palsies and exophthalmos. Angiography is diagnostic.
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.
Proceedings of the 41st Annual Upper Midwest Neuro-Ophthalmology Group Meeting, July 26, 2019, Chicago, Illinois, USA
Published in Neuro-Ophthalmology, 2019
Sasha A. Mansukhani, John J. Chen
Bahareh Hassanzadeh, MD, OSF Illinois Neurological Institute, presented a 64-year-old man with constant right eye and periorbital pain, and intermittent right eye blurred vision for two years. The retinal arteries of the right eye were mildly tortuous compared with the left. Magnetic resonance imaging of the brain and orbits, and a computed tomography angiogram were unremarkable. Fluorescein angiography, however, showed ischaemic changes in the retina of the right eye. Conventional brain angiography was thus performed which found the culprit a right–sided, slow flow, indirect carotid cavernous fistula.