The authors present a retrospective study using the Rochester Epidemiology Project database. The aim was to establish the incidence of carotid-cavernous fistulas (CCF) and outline the associated neuro-ophthalmic patterns. Cases were identified from the database using the following criteria: a confirmed diagnosis of CCF over a 22-year period, aged 18 years or older and resident in a specified county. A range of terms around CCF were used to search the database. A total of 10 cases were identified, therefore the incidence was calculated to be 0.37 per 100,000 per year. The majority were indirect CCF (90%), with a median age of 50.5 years old. Thirty percent were incidental findings and were asymptomatic. The authors present the neuro-ophthalmic findings for six cases, including: sixth cranial nerve palsy (CNP) (100%), chemosis (100%), proptosis (66.7%), pain (50.0%), third CNP (33.3%), audible bruit (33.3%), ocular hypertension (16.7%), and blurred vision (16.7%). A total of five cases were misdiagnosed initially, with a variety of preliminary diagnoses including conjunctivitis and migraine. The median time between onset and diagnosis was 6.5 weeks. The authors acknowledge several limitations of this study, including retrospective methodology and the sub-urban region specified in the inclusion criteria may have less trauma presentations. This study supports previous reports that CCF is an uncommon condition.
How common are carotid-cavernous fistulas and what are the neuro-ophthalmic manifestations?
Reviewed by Lauren Hepworth
Evaluating the incidence and neuro-ophthalmic manifestations of carotid-cavernous fistulas.
CONTRIBUTOR
Lauren R Hepworth
University of Liverpool; Honorary Stroke Specialist Clinical Orthoptist, Northern Care Alliance NHS Foundation Trust; St Helen’s and Knowsley NHS Foundation Trust, UK.
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