Advertisement

Acta Neurochirurgica

, Volume 153, Issue 6, pp 1297–1302 | Cite as

Controlateral cavernous syndrome, brainstem congestion and posterior fossa venous thrombosis with cerebellar hematoma related to a ruptured intracavernous carotid artery aneurysm

  • Sorin Aldea
  • Pierre Guedin
  • Luca Roccatagliata
  • Anne Boulin
  • Stéphanie Auliac
  • Michel Dupuy
  • Charles Cerf
  • Stéphan Gaillard
  • Georges Rodesch
Case Report

Abstract

Intracavernous carotid artery aneurysms (ICCAs) are rarely associated with life-threatening complications. We describe a 55-year-old woman who, after the rupture of an intracavernous carotid artery aneurysm, presented with a contralateral cavernous sinus syndrome and severe posterior fossa and spinal cord symptoms. Following parent artery occlusion, thrombosis of the posterior fossa and spinal cord veins caused a progressive worsening of the neurological status to a “locked-in” state. The patient fully recovered with anticoagulation therapy. Comprehension of the pathophysiological mechanism associated with the rupture of ICCA and early diagnosis of the related symptoms are essential in order to plan a correct treatment that includes the management of the aneurysm rupture and of possible complications related to venous thrombosis.

Keywords

Intracavernous internal carotid artery aneurysm Carotido-cavernous fistula Venous thrombosis Heparin 

Notes

Conflicts of interest

None.

References

  1. 1.
    Andaluz N, Tomsick TA, Keller JT, Zuccarello M (2006) Subdural hemorrhage in the posterior fossa caused by a ruptured cavernous carotid artery aneurysm after a balloon occlusion test. Case report. J Neurosurg 105(2):315–319PubMedCrossRefGoogle Scholar
  2. 2.
    Bussiere M, Lownie SP, Pelz DM, Nicolle D (2009) Direct carotid-cavernous fistula causing brainstem venous congestion. J Neuroophthalmol 29(1):21–25PubMedGoogle Scholar
  3. 3.
    Coutinho JM, Ferro JM, Canhao P, Barinagarrementeria F, Cantú C, Bousser MG, Stam J (2009) Cerebral venous and sinus thrombosis in women. Stroke 40(7):2356–2361PubMedCrossRefGoogle Scholar
  4. 4.
    Fox AJ, Vinuela F, Pelz DM, Peerless SJ, Ferguson GG, Drake CG, Debrun G (1987) Use of detachable balloons for proximal artery occlusion in the treatment of unclippable cerebral aneurysms. J Neurosurg 66(1):40–46PubMedCrossRefGoogle Scholar
  5. 5.
    Kupersmith MJ, Hurst R, Berenstein A, Choi IS, Jafar J, Ransohoff J (1992) The benign course of cavernous carotid artery aneurysms. J Neurosurg 77(5):690–693PubMedCrossRefGoogle Scholar
  6. 6.
    Lasjaunias P, Berenstein A, Terbrugge K (2001) The cavernous sinus region. In: Surgical neuroangiography. Vol 1. Clinical vascular anatomy and variations, 2nd edn. Springer, Berlin Heidelberg New York, pp 389–425Google Scholar
  7. 7.
    Linskey ME, Sekhar LN, Hirsch W Jr, Yonas H, Horton JA (1990) Aneurysms of the intracavernous carotid artery: clinical presentation, radiographic features, and pathogenesis. Neurosurgery 26(1):71–79PubMedCrossRefGoogle Scholar
  8. 8.
    Linskey ME, Sekhar LN, Hirsch WL Jr, Yonas H, Horton JA (1990) Aneurysms of the intracavernous carotid artery: natural history and indications for treatment. Neurosurgery 6(6):933–937, discussion 937–938Google Scholar
  9. 9.
    Murata H, Kubota T, Murai M, Kanno H, Fujii S, Yamamoto I (2003) Brainstem congestion caused by direct carotid-cavernous fistula—case report. Neurol Med Chir (Tokyo) 43(5):255–258CrossRefGoogle Scholar
  10. 10.
    Rhoton AL (2002) The cerebral veins. Neurosurgery 51(4 Suppl):S159–S205PubMedGoogle Scholar
  11. 11.
    Rhoton AL (2002) The sellar region. Neurosurgery 51(4 Suppl):S335–S374PubMedGoogle Scholar
  12. 12.
    Rhoton AL (2002) The cavernous sinus, the cavernous venous plexus, and the carotid collar. Neurosurgery 51(4 Suppl):S375–S410PubMedGoogle Scholar
  13. 13.
    Shintani S, Tsuruoka S, Shiigai T (2000) Carotid-cavernous fistula with brainstem congestion mimicking tumor on MRI. Neurology 55(12):1929–1931PubMedGoogle Scholar
  14. 14.
    Shownkeen H, Bova D, Origitano TC, Petruzzelli GJ, Leonetti JP (2001) Carotid-cavernous fistulas: pathogenesis and routes of approach to endovascular treatment. Skull Base 11(3):207–218PubMedCrossRefGoogle Scholar
  15. 15.
    Stiebel-Kalish H, Kalish Y, Bar-On RH, Setton A, Niimi Y, Berenstein A, Kupersmith MJ (2005) Presentation, natural history, and management of carotid cavernous aneurysms. Neurosurgery 57(5):850–857, discussion 857PubMedCrossRefGoogle Scholar
  16. 16.
    Teng MM, Chang T, Pan DH, Chang CN, Huang CI, Guo WY, Chen CC, Pang RG, Lee LS (1991) Brainstem edema: an unusual complication of carotid cavernous fistula. AJNR Am J Neuroradiol 12(1):139–142PubMedGoogle Scholar
  17. 17.
    Turner DM, Vangilder JC, Mojtahedi S, Pierson EW (1983) Spontaneous intracerebral hematoma in carotid-cavernous fistula. Report of three cases. J Neurosurg 59(4):680–686PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2011

Authors and Affiliations

  • Sorin Aldea
    • 1
    • 4
  • Pierre Guedin
    • 2
  • Luca Roccatagliata
    • 2
  • Anne Boulin
    • 2
  • Stéphanie Auliac
    • 2
  • Michel Dupuy
    • 1
  • Charles Cerf
    • 3
  • Stéphan Gaillard
    • 1
  • Georges Rodesch
    • 2
  1. 1.Department of NeurosurgeryHopital FochSuresnesFrance
  2. 2.Department of NeuroradiologyHopital FochSuresnesFrance
  3. 3.Department of Intensive CareHopital FochSuresnesFrance
  4. 4.Service de NeurochirurgieHopital FochSuresnesFrance

Personalised recommendations