2023 Volume 8 Issue 3 Pages 118-124
Objective: We report a rare case of a traumatic middle meningeal arteriovenous fistula (AVF) with eye symptoms similar to internal carotid cavernous sinus fistula caused by a contrecoup injury.
Case Presentation: A 47-year-old woman suffered from a left temporal cerebral contusion secondary to a fall while cycling. CT imaging showed a contrecoup contusion and subarachnoid hemorrhage in the right temporal lobe. A day after she fell, the patient developed right eye ptosis, and digital subtraction angiography (DSA) revealed a middle meningeal AVF. The fistula was found at the right middle cranial fossa and supplied by the right middle meningeal artery and drained into the superior ophthalmic vein via the middle meningeal vein and cavernous sinus. Given the mild nature of her symptoms, conservative management was chosen. However, follow-up DSA revealed spontaneous obstruction of the AVF with pseudoaneurysm formation at the shunting point. Complete embolization of the latter was achieved using coils and glue.
Conclusion: Middle meningeal AVFs caused by contrecoup contusion often occur in the middle cranial fossa. Close radiographical follow-up is necessary to monitor the formation of a pseudoaneurysm after identifying a spontaneous fistula obstruction, as false aneurysms respond well to endovascular therapy.
