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Recovery From Ophthalmoplegia and Proptosis After Repair of Bilateral Carotid-Cavernous Sinus Fistulas

Edilberto Amorim, MD1; Brian T. Jankowitz, MD1; Tudor G. Jovin, MD1; Ashutosh P. Jadhav, MD, PhD1
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1Department of Neurology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
JAMA Neurol. 2013;70(12):1584-1585. doi:10.1001/jamaneurol.2013.1515.
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A carotid-cavernous sinus fistula is an anomalous communication of dural branches from the intracerebral artery or external carotid artery to the cavernous sinus. Spontaneous carotid-cavernous sinus fistulas have been associated with the presence of ruptured carotid aneurysms, atherosclerosis, diabetes mellitus, and genetic disorders such as Ehlers-Danlos syndrome or fibromuscular dysplasia. However, bilateral spontaneous carotid-cavernous sinus fistulas are still considered uncommon.1,2

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Figure.
Photographs and Cerebral Angiograms of a 36-Year-Old Man With Bilateral Carotid Cavernous Sinus Fistulas

At presentation, there was limited abduction with rightward (A) and leftward (B) lateral gaze, and cerebral angiograms revealed bilateral carotid cavernous sinus fistulas (C [arrowhead]) that were completely embolized (D [arrowhead]). One month after treatment, there was improvement in abduction with rightward (E) and leftward (F) gaze.

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