2022 年 45 巻 2 号 p. 61-65
Background: Traumatic carotid–cavernous fistula (tCCF) is rare arteriovenous shunt between carotid artery and cavernous sinus, resulting from head injury. The symptoms in tCCF typically present within several weeks after injury.
We report the rare case of delayed tCCF 4–month after head injury.
Case presentation: A 86–year–old man suffered right–sided head injury due to a fall while walking. He was diagnosed with left–sided subdural hematoma and contusion, but no cranial fractures. He had a symptom of headache and nausea, but no cranial nerve palsy. There were no evidence of cerebrovascular disease including tCCF on initial and 15–day follow–up MRI. Four–month after the injury, he suffered from sudden onset of diplopia. MRI revealed the right–sided tCCF draining to the ipsilateral superior ophthalmic vein, inferior petrosal sinus, and intercavernous sinus. Two–stage transvenous coil embolization was performed, and the tCCF was eliminated via selective occlusion. His diplopia was completely resolved at 1–month follow–up.
Conclusion: tCCF should be considered even in the chronic stage of head injury. We recommend a longer follow–up period of 6 months after a head injury.
