Delayed diagnosis of traumatic internal carotid-cavernous sinus fistula due to multiple trauma

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  • Kobayashi Tomoyuki
    Department of Emergency and Critical Care Medicine, Hyogo College of Medicine
  • Nitta Syo
    Department of Emergency and Critical Care Medicine, Hyogo College of Medicine
  • Hasegawa Kana
    Department of Emergency and Critical Care Medicine, Hyogo College of Medicine
  • Sato Kiyoko
    Department of Emergency and Critical Care Medicine, Hyogo College of Medicine
  • Shirai Kunihiro
    Department of Emergency and Critical Care Medicine, Hyogo College of Medicine

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Other Title
  • 多発外傷において診断が遅れた外傷性内頚動脈海綿静脈洞瘻の合併例
  • タハツ ガイショウ ニ オイテ シンダン ガ オクレタ ガイショウセイ ナイ ケイドウミャク カイメン ジョウミャクドウロウ ノ ガッペイレイ

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<p>  It is well known that internal carotid artery aneurysm, dissection, and internal carotid‒cavernous sinus fistula (CCF) occur secondary to cerebrovascular injury due to severe head trauma. The effectiveness of endovascular treatment for these is high and reliable treatment is possible, so early diagnosis is important. We report a case of spontaneous cure of traumatic CCF in which priority was given to the treatment of trunk trauma, and in which recognizing the presence of traumatic subarachnoid hemorrhage resulted in a delayed diagnosis and severe sequelae. Our patient was a 17‒year‒old male with multiple trauma caused by a traffic accident. Although traumatic subarachnoid hemorrhage and pneumocephalus were found in the skull base on head computed tomography (CT), diagnosis and treatment were prioritized to first address intraperitoneal hemorrhage and hemorrhagic shock due to splenic injury. Cerebral infarction was observed on head CT on Day 3. From the beginning, a large amount of epistaxis, skull base fracture, and traumatic internal carotid artery injury were symptomatically suggested, but the patient’s condition could not be fully understood due to severe disturbance of consciousness without eye symptoms. On Day 5, when CT angiography was performed, CCF and internal carotid artery dissection were confirmed. Extensive cerebral infarction had already appeared, and conservative treatment was selected based on the patient’s condition. Spontaneous cure of CCF was confirmed by follow‒up CT, but the patient was transferred to the hospital 60 days after admission due a residual modified Rankin Scale score of 5 and severe dysfunction. For severe head trauma, it is important to consider the possibility of cerebral vascular injury and to diagnose it early using techniques such as angiography if symptoms or imaging findings suggesting it are observed.</p>

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