1Damelan Kombate, 2Diatewa Euberna José, 2Guinhouya Kokou Mensah, 1Kumako Vinyo, 2Bélo Mofou, 2Balogou Aa. Koffi

1University of Kara, Kara, Togo; 2University of Lomé, Lomé, Togo

Background:

The carotid-cavernous fistula (CCF) is a communication between the internal carotid artery and the cavernous sinus vein. This is a rare condition. It is often described in trauma but the CCF can be spontaneous. CCF can be direct in traumatic condition (direct communication between intra-cavernous carotid artery and the cavernous sinus vein) or indirect.

Objective:

We report a case of CCF.

Case Report:

A 43-year lady, right-handed, single and mother of two children, was admitted in emergency neurology for intense headaches with vomiting, 2 generalized seizures and a sudden onset of consciousness disorders on April 19, 2016. Symptoms began two hours before her admission. She had no vascular history. The physical examination revealed intense headaches. The blood pressure was 130/80 mmHg with normal temperature (36.8 ° C). There was a light comas status with a Glasgow score of 12/15, a stiff neck, left hemiparesis and a bilateral Babinski reflex, right ptosis associated with reactive mydriasis, an exophthalmos and a total right ophthalmoplegia. Ophthalmologic examination revealed a right visual acuity of 1/10 with macular chorioretinitis. The brain CT scan (figure) displayed a dilatation and  hyper-density of  right  cavernous sinus with dilatation of the right ophthalmic vein associated with a subarachnoid hemorrhage. The routine biological tests were normal.  An analgesic treatment had been administered in  addition  to  nimodipine  and  mannitol (against   brain   edema)   and   clonasepam  (against seizures). Unfortunately, as interventional neuroradiology and arteriography are not available, the patient had died on the seventh day of hospitalization in a context of increased intracranial hypertension.

Conclusion(s):

In developing countries, the management of CCF is very difficult because of the lack of  interventional neuroradiological  platform.   Arteriography is appropriate for diagnosis and endovascular treatment.