Doppler ultrasound in carotid-cavernous fistula diagnosis and follow-up: brief literature review and case report

The brief review presents the main classifications, clinical manifestations, and diagnostic tools for carotid-cavernous fistulas. Ultrasound criteria of direct (high-speed) and indirect (low-speed) carotidcavernous fistulas diagnosis are considered in detail. The article presents a clinical case of direct carotid-cavernous fistula in a 35-year-old patient, occurring following traumatic brain injury. No signs of vascular brain pathology on MR-angiography in the emergency setting were revealed. Due to the clinical worsening (1 month after traumatic brain injury) Doppler ultrasound was performed. The following ultrasound signs were found: an increase of the right internal carotid artery diameter (6.4 mm versus 5.1 mm on the contralateral side), an increase of peak systolic velocity (105 cm/s versus 86 cm/s on the contralateral side) with a decrease of resistance index (0.43 versus 0.65 on the contralateral side); abnormal mosaic flow flash (3.5 cm2) in the right cavernous sinus area; an increase of the right superior ophthalmic vein diameter (3.3 mm versus 1.9 mm on the contralateral side) with blood flow arterialization and inversion of flow direction. The diagnosis confirmed by digital subtraction angiography and MR-angiography. The patient was undergoing surgical treatment. No signs of pathology were found on control Doppler ultrasound 3 month after surgery. This clinical case demonstrates the value of ultrasound in early recognition of the carotid-cavernous fistula and postsurgical follow-up.

ultrasound, transcranial Doppler, carotid-cavernous fistula, direct carotid-cavernous fistula, dural carotid-cavernous fistula, high flow carotid-cavernous fistula, low flow carotid-cavernous fistula, superior ophthalmic vein

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