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Cavernous Sinus Aneurysm


Presentation

  • A 60-year-old woman presented with a cerebellar solid tumor manifesting as headache of 4 months, progressive vomiting, and ataxia of half a month.[ncbi.nlm.nih.gov]
  • […] clinical presentations, treatments, and outcomes.[ncbi.nlm.nih.gov]
  • Clinical presentation is usually an acute onset of ocular symptoms and a pulsatile bruit is invariably present.[ajnr.org]
  • Mass effect is the most common presentation for non-traumatic cavernous internal carotid artery aneurysms, with only 3% presenting with hemorrhage [ 7 ].[omicsonline.org]
  • BILATERAL aneurysms involving the internal carotid artery in the cavernous sinus are rare and present difficulties in diagnosis and treatment. Among 75 verified aneurysms, only a single instance of such an aneurysm has been encountered.[jamanetwork.com]
Anosmia
  • الصفحة 130 - The syndrome of anosmia with hypogonadotropic hypogonadism: a genetic study of 18 new families and a review. Am J Med Genet 1983;15:417-435. ‏ الصفحة 121 - Jeffery DR, Mandler RN, Davis LE. Transverse myelitis.[books.google.com]
Sneezing
  • Since the onset of illness patient has no history of coma and loss of consciousness, no fever, no head and face pain and no visual changes, no nasal itching, sneezing, purulent nasal discharge and other symptoms.[omicsonline.org]
Nasal Discharge
  • Since the onset of illness patient has no history of coma and loss of consciousness, no fever, no head and face pain and no visual changes, no nasal itching, sneezing, purulent nasal discharge and other symptoms.[omicsonline.org]
Vascular Disease
  • Direct CCFs may result from: Trauma Rupture of a cavernous carotid aneurysm A tear in the wall of a weak cavernous internal carotid artery caused by congenital collagen vascular disease.[upmc.com]
  • Etiology Direct CCF may result from trauma, rupture of a cavernous carotid aneurysms, or from a tear in the wall of a congenitally weak cavernous ICA secondary to collagen vascular disease. Indirect CCF are usually spontaneous and idiopathic.[neurosurgery.pitt.edu]
  • Spontaneous fistulae usually result from a ruptured carotid aneurysm, in collagen vascular disease, atherosclerotic disease, hypertension, or at childbirth 3 . 2. Flow: high or low flow 3.[sonoworld.com]
  • Causes [ edit ] Carotid cavernous fistulae may form following closed or penetrating head trauma, surgical damage, rupture of an intracavernous aneurysm, or in association with connective tissue disorders, vascular diseases and dural fistulas.[en.wikipedia.org]
Skin Discoloration
  • The swelling was also accompanied by skin discoloration and pus discharge (Figure 1) . She was referred to us for further management of her condition. On general examination, the patient looked ill and pallor was noted on the palms.[ijcasereportsandimages.com]
Tinnitus
  • Sigmoid sinus diverticulum and pulsatile tinnitus: analysis of CT scans from 15 cases.[connection.ebscohost.com]
  • Swelling of the membranes that cover the outside of the eyes and line the eyelids Forward displacement of the eyeballs Deteriorating vision Cranial nerve palsies Nosebleed Headache Bruit (a blowing sound in the vessel that can be heard with a stethoscope) Tinnitus[upmc.com]
  • Cranial nerve palsies, epitaxis, headache, bruit, and tinnitus may be present with either anterior or posterior drainage. Rare cases with subarachnoid hemorrhage.[neurosurgery.pitt.edu]
Pulsatile Tinnitus
Diplopia
  • Seven patients complained of horizontal diplopia, whereas two had vertical diplopia and one had oblique diplopia. The nature of the diplopia in the remaining nine patients was not specified.[jnnp.bmj.com]
  • Kim First published December 26, 2006, DOI: A 54-year-old man developed sudden left-sided headache and diplopia. There was complete left ophthalmoplegia and decreased sensation in the ophthalmic and maxillary divisions of the trigeminal nerve.[neurology.org]
  • Diplopia is secondary due to the compression of cranial nerves by aneurysm [ 10 ].[omicsonline.org]
  • Bardram , OCULOMOTOR PARESES AND NON-PARETIC DIPLOPIA IN PITUITARY ADENOMATA, Acta Ophthalmologica , 2009 , 27 , 2, 225 Wiley Online Library 8 Lester L. Lansky , John A.[onlinelibrary.wiley.com]
  • Cavernous sinus tumors Acute or slowly progressive ophthalmoplegia is the dominant presentation, with diplopia being the most common symptom. At times, painful diplopia is present. Usually the patient has a preceding history of cancer.[emedicine.medscape.com]
Painful Ophthalmoplegia
  • ophthalmoplegia Orbital congestion, lid chemosis, proptosis Visual loss, optic disc edema (unilateral) Signs of meningeal irritation Miscellaneous cavernous sinus lesions Tolosa-Hunt syndrome: Isolated or combined, painful ophthalmoplegia Herpes zoster[emedicine.medscape.com]
  • Case Description: A 53-year-old woman suffered severe left painful ophthalmoplegia. A magnetic resonance image (MRI) revealed thickness of the left cavernous sinus (CS).[surgicalneurologyint.com]
  • Most common causes are tumor (e.g. meningiomas) There is another described pathology within the cavernous sinus and superior orbital fissure that presents with painful ophthalmoplegia known as Tolosa Hunt Syndrome.[eyewiki.aao.org]
Pulsating Exophthalmos
  • exophthalmos, lid congestion, conjunctival chemosis, orbital congestion, ocular hypertension, visual loss, optic neuropathy, optic disc edema, retinal hemorrhages, retinal venous congestion, and loud ocular and cranial bruit Indirect: Similar signs and[emedicine.medscape.com]
Unilateral Blindness
  • Triad of unilateral blindness, orbital fractures and massive epistaxis’ after head injury. J. Neurosurg., 1961;18: 837. 5. Mahmoud, NA. Traumatic aneurysm of the internal carotid artery and epistaxis. (Review of literature and report of a case). J.[jpma.org.pk]
Head and Neck Swelling
  • The manifestations included arm, head and neck swellings in 97% of the patients, which coincide with the findings in the patient being reported, and pulmonary embolism in 36% of the patients.[ijcasereportsandimages.com]

Workup

  • Differential diagnoses include orbital cellulitis, orbital apex syndrome, ICA aneurysm, malignancy of the CS, trauma, carotid-cavernous fistula (CCF), Tolosa-Hunt Syndrome, and ischemic stroke (6,14) Workup If CST is suspected, imaging should be ordered[emdocs.net]
  • Nevertheless, basic workup must be done.[eyewiki.aao.org]
  • The patient was admitted for further workup. A brain MRI demonstrated metastatic involvement of the cavernous sinus ( Figures 3, 4 ).[touchoncology.com]

Treatment

  • Abstract Proximal occlusion of the internal carotid artery (ICA) is still the treatment of choice for a large cavernous sinus aneurysm.[ncbi.nlm.nih.gov]
  • Endovascular treatment with coils is effective in occluding the fistula.[ncbi.nlm.nih.gov]
  • Endovascular treatment of a giant internal carotid artery bifurcation aneurysm with drainage into cavernous sinus Chin Med J, 2012,125(03) : 539-542.[cmj.yiigle.com]
  • Treatment Twenty one of the 31 patients (68%) underwent treatment of their CCAs (table 3).[jnnp.bmj.com]

Prognosis

  • Brain aneurysm: A cavernous aneurysm is a common finding that if truly cavernous, indicates that it is located outside of the brain and generally carries a benign prognosis.[healthtap.com]
  • The long term prognosis for treated cases is relatively good, with most complications occurring immediately after the procedure.[jnnp.bmj.com]
  • Because of the dismal prognosis of the malignancy and contraindication of antiaggregative drugs for reasons of a single hemorrhagic metastasis in the right cerebellar hemisphere, the multidisciplinary decision was made to refrain from endovascular treatment[jbsr.be]
  • prognosis for dural CCF is very good.[eyewiki.org]

Etiology

  • Conclusion: Epistaxis related to internal carotid artery aneurysm is quite rare but it is important to consider aneurysms in the etiology of epistaxis. Which may be fatal if the cause of nasal bleeding cannot be identified.[omicsonline.org]
  • CSS has a multitude of etiologies.[touchoncology.com]
  • The most common known etiology is a posterior communicating artery aneurysm. This is a medical emergency.[eyewiki.aao.org]
  • Etiology and therapy of the internal jugular vein thrombosis. Laryngorhinootologie 2004 Nov;83(11):743–9. [Article in German]. [ Pubmed ][ijcasereportsandimages.com]
  • The differential diagnosis of a cavernous sinus syndrome includes a wide array of vascular, infectious, inflammatory, and neoplastic etiologies. Fortunately, among vascular lesions, cavernous aneurysms are usually indolent and rarely rupture.[synchropublisher.com]

Epidemiology

  • Cavernous carotid artery aneurysms: Epidemiology, natural history, diagnostic and treatment. An experience of a single institution. Clin Neurol Neurosurg 2014;125:32-5. [ PUBMED ] 4.[neurologyindia.com]
Sex distribution
Age distribution

Pathophysiology

  • We briefly reviewed the literature of similar cases and tried to analyze the possible pathophysiological relationship between these findings.[moh-it.pure.elsevier.com]
  • Dural carotid cavernous fistula Pathophysiology Direct carotid cavernous fistula – Arise most commonly secondary to a traumatic tear of internal carotid artery within the cavernous sinus.[eyewiki.org]
  • In some cases, the precise site of the lesion is clear, whereas in others, the location of the lesion is speculative. [1] Pathophysiology To understand the pathophysiology of the oculomotor nerve palsy it is essential to know its track.[eyewiki.aao.org]
  • Pathophysiology The two cavernous sinuses are located on both sides of the sella turcica.[emdocs.net]
  • Discussion Several classifications of CCF exist depending on anatomy, aetiology, and pathophysiology. One categorisation divides between traumatic and spontaneous fistulas.[jnnp.bmj.com]

Prevention

  • Page 344 - Primary prevention of ischemic stroke: A statement for healthcare professionals from the Stroke Council of the American Heart Association. ‎[books.google.com]
  • Although CCFs from ruptured cavernous sinus aneurysms may close spontaneously, as in 2 of our patients with low-flow CCFs, angiography and endovascular closure of the fistula should follow promptly to prevent possible hemorrhage from engorged cortical[ajnr.org]
  • To contain the infection, the body's immune system creates a clot to prevent bacteria or other pathogens from spreading. The clot increases pressure inside the brain . This pressure can damage the brain and may ultimately cause death.[webmd.com]
  • To contain the infection, the body's immune system creates a clot to prevent bacteria or other pathogens from spreading. The clot increases pressure inside the brain. This pressure can damage the brain and may ultimately cause death.[webmd.com]
  • The combination of coils and thrombus forms a plug which prevents blood from going into the aneurysm, and protects the aneurysm from rupture. Depending on the shape of the aneurysm, the coils may have a hard time staying inside.[med.nyu.edu]

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