抄録
We report the case of a 58-year-old man with head injury, without any focal neurological deficit. Computed tomography demonstrated multiple skull fractures, an acute epidural hematoma, and bleeding in the sphenoid sinus. Two days after the injury, the patient developed motor aphasia with gradually progressing pulsatile proptosis, bruit, and external ophthalmoplegia on the left side, and bilateral conjunctival congestion. Magnetic resonance imaging showed venous congestion in the left frontal and temporal lobes. Cerebral angiography revealed a direct carotid cavernous fistula (CCF), two aneurysms of the right middle meningeal artery (MMA), dural arteriovenous fistulas (dAVFs) from bilateral MMAs and a dAVF into the superior sagittal sinus. We occluded the left internal carotid artery, and one of the MMA aneurysms was removed by open surgery. Complex head trauma or skull base injuries may occur in association with a secondary cerebrovascular disease (CVD). Evaluation of secondary CVDs is needed in case of delayed neurological deficits after such head injuries.
