In this report, we present a rare case of traumatic carotid cavernous fistula that was occluded during the interventional procedure by incidentally formed blood clot. Sudden occlusion of the fistula and the resolution process of the precarious blood clot can be clearly seen on the serial angiogram.
Vascular Surgical Procedures/*adverse effects ; Treatment Outcome ; Male ; Incidental Findings ; Humans ; Craniocerebral Trauma/*complications ; Carotid-Cavernous Sinus Fistula/etiology/*radiography/*surgery ; Carotid Artery Thrombosis/*etiology/*radiography ; Adult

Although isolated cranial nerve palsies are common in diabetic patients, multiple, simultaneous cranial neuropathies are rare. We describe the second case of a complete superior orbital fissure syndrome including the optic nerve in a middle-aged Papuan man with newly diagnosed diabetes mellitus. The differential diagnosis included septic cavernous sinus thrombosis and Tolosa Hunt syndrome, and management was initially directed at excluding these serious, treatable conditions.
Cavernous Sinus Thrombosis - diagnosis ; Diabetes Mellitus, Type 2 - complications ; Diabetes Mellitus, Type 2 - diagnosis ; New Guinea ; Oculomotor Nerve Diseases - diagnosis ; Oculomotor Nerve Diseases - etiology ; Tolosa-Hunt Syndrome - diagnosis

OBJECTIVETo discuss the clinical diagnosis and treatment of cavernous sinus syndrome caused by fungal infection of sphenoid sinus.

METHODSThe clinical manifestations, imaging examination, operation methods and complications were analyzed retrospectively in 9 patients with fungal infection of sphenoid sinus treated between January 2007 and September 2012, and the clinical experience was summarized. The treatment methods included endoscopic operation combined with antifungal drugs, and the primary disease was treated actively at the same time.

RESULTSAfter treatment, one patient with cavernous sinus thrombophlebitis had complications of ptosis, eyeball fixation and could only see the moving finger in the serious eye, while the contralateral eye regained normal vision. One patient with hypoproteinemia mucormycosis and diabetic remained blindness, eyeball fixation and ptosis in the left eye. In 3 patients, the vision was improved, but the eyeball movement was still limited. In another 3 patients, there was no significant recovery of vision, with one eye fixed in movement. The symptoms in 1 patient disappeared completely. All patients had no other systemic complications.

CONCLUSIONSCavernous sinus syndrome caused by the fungal infection of sphenoid sinus is rare. It is commonly happened in patients with systemic disease or immunocompromised patients. Early detection and parallel operation and continuous antifungal therapy can reduce the damage, but the prognosis is poor.

Adolescent ; Adult ; Aged ; Antifungal Agents ; therapeutic use ; Cavernous Sinus Thrombosis ; etiology ; therapy ; Child ; Combined Modality Therapy ; Female ; Humans ; Male ; Middle Aged ; Mycoses ; complications ; Retrospective Studies ; Sphenoid Sinus ; Sphenoid Sinusitis ; complications ; Young Adult

A 62-year-old woman has been suffered from cavernous sinus thrombophlebitis which was confirmed by four-vessel angiography, orbit magnetic resonance imaging, and blood culture. Three weeks after recovery of cavernous sinus thrombophlebitis, right eye proptosis and complete third, fourth, and sixth cranial nerve palsies developed. Best-corrected visual acuity decreased to 20/70 in the right eye. Repeat magnetic resonance imaging demonstrated a 1.5-cm-sized mass in the right cavernous sinus, suspicious for mycotic aneurysm. Amphotericin B supplementation was begun and was followed by successful transarterial Guglielmi detachable coil embolization. Four months later, extraocular movement was normalized, and visual acuity improved to 20/25 in the right eye.
Amphotericin B/therapeutic use ; Aneurysm, Infected/*etiology/*therapy ; Angiography ; Antifungal Agents/therapeutic use ; Cavernous Sinus Thrombosis/*complications ; Embolization, Therapeutic/*methods ; Female ; Humans ; Magnetic Resonance Imaging ; Middle Aged ; Visual Acuity