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Spontaneous Resolution of Two Dural Carotid-Cavernous Fistulas Presenting With Optic Neuropathy and Marked Congestive Ophthalmopathy

Bujak, Mathew MD, FRCSC; Margolin, Edward MD, FRCSC; Thompson, Andrew MD; Trobe, Jonathan D MD

doi: 10.1097/WNO.0b013e3181ceb483
Original Contributions

Two patients with dural carotid-cavernous fistulas (CCFs) presented with optic neuropathy and marked congestive ophthalmopathy, including 1 patient with a narrowed anterior chamber angle due to choroidal effusions. Endovascular intervention was planned but deferred for logistic reasons. While the patients awaited the procedures, the clinical features markedly improved, and time-resolved imaging of contrast kinetics (TRICKS) MRA was consistent with closure of the CCFs. These patients serve as a reminder that spontaneous resolution may occur in dural CCFs even when presenting clinical features are florid and vision appears to be threatened. In fact, a rapid worsening of clinical manifestations may be a sign that a dural CCF is about to close spontaneously.

Departments of Ophthalmology and Visual Sciences (MB, EM) and Medical Imaging (AT), University of Toronto, Toronto, Ontario, Canada; and Department of Ophthalmology and Neurology (JDT), University of Michigan, Ann Arbor, Michigan.

Address correspondence to Edward Margolin, MD, FRCSC, Department of Ophthalmology and Visual Sciences, University of Toronto, Mount Sinai Hospital, 600 University Avenue, Suite 409, Toronto, ON M5G 1X5, Canada; E-mail: edmargolin@gmail.com

© 2010 Lippincott Williams & Wilkins, Inc.