Painful Blindness: A Diagnosis not to be Missed

García-García ME, Azorín DG, Almonacid JJ and Dolado AM

Neurology Department, Hospital Clínico San Carlos, Spain

^*Correspondance to: María Eugenia García-García 

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Abstract:

A 62-year-old female was admitted with a history of left sided headache, mild proptosis and left ocular redness occurring during the last weeks. A brain MRI showed findings suggesting a carotid fistula. The cerebral angiogram highlighted an indirect Barrow type D left carotid-cavernous fistula which was treated with embolization. The following day, the patient complained of left retro-orbital pain and loss of vision. The examination showed the following findings (in the left eye): mydriatic nonreactive pupil, vision loss, conjunctivalchemosis and an intraocular pressure of 33 mmHg. The new angiogram showed an almost complete closure of the fistula and the brain MRI demonstrated a choroidal detachment along the medial wall of the left ocular globe which provoked acute angle closure glaucoma. Considering that an early diagnosis and treatment are crucial to the prognosis, neuro-ophthalmologists should consider this entity in the differential diagnosis of a patient with worsening ocular symptoms after a carotid-cavernous fistula embolization

Keywords:

Carotid-Cavernous fistula; Choroidal detachment; Angle closure glaucoma; Embolization; Angiography cerebral

Cite the Article:

García-García ME, Azorín DG, Almonacid JJ, Dolado AM. Painful Blindness: A Diagnosis not to be Missed. Ann Clin Case Rep. 2016; 1: 1059.