経静脈的塞栓術後に眼所見が改善した特発性頸動脈海綿静脈洞瘻の1例

Intravenous embolization procedure improved ocular manifestations in a case of spontaneous carotid-cavernous sinus fistula

　74歳の女性に頭痛と複視が発症し，左滑車神経麻痺と診断された。6か月後に左眼底に網膜静脈拡張が生じた。脳血管造影で左側の特発性頸動脈海綿静脈洞瘻（CCF）が同定された。その2か月後に左眼に網膜中心静脈閉塞症が発症し，矯正視力が0.2に低下した。経静脈的栓塞術が行われ，その2週後に球結膜の静脈拡張が消失し，6週後に眼球運動がほぼ正常化した。手術の5か月後に視力は0.9に改善した。CCFが滑車神経麻痺の原因になりうることと，視力低下のあるCCFには早期手術を行うべきことが結論される。

A 74-year-old female developed headache and diplopia. She was diagnosed with left trochlear nerve palsy.Six months later, her left eye showed congestive signs. Cerebral angiography showed ipsilateral spontaneous carotid-cavernous sinus fistula (CCF) . Another 2 months later, the left eye developed central retinal vein occlusion with thevisual acuity reduced to 0.2. Transvenous embolization induced disappearance of venous congestion in the bulbar conjunctiva 2 weeks later and normalization of ocular movements 6 weeks later. Left visual acuity improved to 0.9 5 months after theprocedure. This case illustrates that CCF may result in trochlear nerve palsy and that early embolization is indicated inCCF with impaired visual acuity.