Hemispheric Laminar Necrosis as a Complication of Traumatic Carotid-Cavernous Sinus Fistula -Case Report-

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  • KATO Masayasu
    Advanced Critical Care Center, Gifu University Hospital Department of Neurosurgery, Gifu University Graduate School of Medicine
  • IKEGAME Yuka
    Advanced Critical Care Center, Gifu University Hospital Department of Neurosurgery, Gifu University Graduate School of Medicine
  • TOYODA Izumi
    Advanced Critical Care Center, Gifu University Hospital
  • OGURA Shinji
    Advanced Critical Care Center, Gifu University Hospital
  • KITAJIMA Hideomi
    Department of Neurosurgery, Gifu University Graduate School of Medicine
  • YOSHIMURA Shinichi
    Department of Neurosurgery, Gifu University Graduate School of Medicine
  • IWAMA Toru
    Department of Neurosurgery, Gifu University Graduate School of Medicine

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  • —Case Report—

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A 43-year-old woman presented with a very rare case of hemispheric laminar necrosis as a complication of traumatic carotid-cavernous sinus fistula (CCF). The patient suffered head injury and extensive burns following a car accident. Oral intubation was performed under sedation. When sedation was discontinued 17 days after injury, the patient demonstrated left hemiparesis. Magnetic resonance imaging showed laminar necrosis affecting the right cerebral hemisphere. Angiography revealed a right high-flow direct CCF. Transarterial embolization of the fistula using a detachable balloon achieved complete occlusion of the fistula. However, the left hemiparesis persisted following this intervention. Traumatic CCF may be missed in patients with disturbed consciousness, so clinicians should not overlook possibility of the triad of symptoms of CCF in patients with head injury.<br>

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