Contralateral extensive cerebral hemorrhagic venous infarction caused by retrograde venous reflux into the opposite basal vein of Rosenthal in posttraumatic carotid-cavernous fistula: A case report and literature review.

Publisher: Sage Publications Country of Publication: United States NLM ID: 9602695 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 2385-2011 (Electronic) Linking ISSN: 15910199 NLM ISO Abbreviation: Interv Neuroradiol Subsets: MEDLINE

Publication: 2015- : Thousand Oaks, CA : Sage Publications
Original Publication: Milan, Udine, Italy : Edizioni del Centauro, [1995-

Cerebral Veins*; Brain Infarction/*diagnostic imaging ; Brain Infarction/*therapy ; Brain Injuries/*diagnostic imaging ; Brain Injuries/*therapy ; Carotid-Cavernous Sinus Fistula/*diagnostic imaging ; Carotid-Cavernous Sinus Fistula/*therapy ; Intracranial Hemorrhages/*diagnostic imaging ; Intracranial Hemorrhages/*therapy; Accidents, Traffic ; Brain Infarction/etiology ; Brain Injuries/complications ; Carotid-Cavernous Sinus Fistula/complications ; Endovascular Procedures ; Female ; Humans ; Imaging, Three-Dimensional ; Intracranial Hemorrhages/etiology ; Magnetic Resonance Angiography ; Magnetic Resonance Imaging ; Middle Aged

We describe a patient with traumatic carotid-cavernous fistula (CCF), subsequently developing contralateral extensive hemorrhagic venous infarction from retrograde venous reflux into the opposite basal vein of Rosenthal. A 54-year-old woman was involved in a motor vehicle accident and sustained severe traumatic brain injury. Two months later, she developed bilateral proptosis and audible bruit. Magnetic resonance imaging (MRI) and magnetic resonance angiography (MRA) of the brain demonstrated the right direct CCF. Fluid-attenuated inversion recovery (FLAIR) images showed a small hyperintense area at the left basal ganglia. Ten days later, she developed right-sided grade 2/5 hemiparesis, facial upper motor neuron weakness, and cognitive impairment. Follow-up MRI showed significant progression of hyperintensities involving the left-sided centrum semiovale, basal ganglia, thalamus, midbrain, pons, cerebellum, basal frontal, temporal lobes, especially subcortical white matter on FLAIR images, and multiple hypointense foci of hemorrhagic component on T2*-weighted gradient-echo images, representing hemorrhagic venous infarction. While waiting for embolization, she rapidly developed right hemiplegia and aphasia, and became somnolent. Under general anesthesia, emergency endovascular treatment was performed successfully to obliterate the fistula without surgical intervention. Five months after endovascular treatment, MRI and MRA confirmed no residual fistula and revealed nearly complete resolution of abnormal increased signal intensity. In the present case, the factors related to the presence of this rare condition were absence of the ipsilateral basal vein of Rosenthal (BVR), occlusion of posterior segment of the contralateral superior petrosal sinus, and a developed uncal vein with hypoplastic second and third segments of the contralateral BVR.

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Keywords: Venous infarction; basal vein of Rosenthal; direct carotid-cavernous fistula; traumatic carotid-cavernous fistula; venous congestion

Date Created: 20180522 Date Completed: 20181211 Latest Revision: 20191001

20240829

PMC6116133

10.1177/1591019918776615

29781369