Extensive basal ganglia edema caused by a traumatic carotid-cavernous fistula: a rare presentation related to a basal vein of Rosenthal anatomical variation

Case report

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  • 1 Department of Radiology, Pontchaillou Hospital, CHU Rennes;
  • 2 Departments of Neuroradiology,
  • 4 Vascular Neurology, and
  • 5 Neurosugery, Pitié-Salpêtrière Hospital, Paris VI University, Paris, France; and
  • 3 Department of Radiology, University of Padova, Italy
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The authors report a very rare presentation of traumatic carotid-cavernous fistula (CCF) with extensive edema of the basal ganglia and brainstem because of an anatomical variation of the basal vein of Rosenthal (BVR). A 45-year-old woman was admitted to the authors' institution for left hemiparesis, dysarthria, and a comatose state caused by right orbital trauma from a thin metal rod. Brain MRI showed a right CCF and vasogenic edema of the right side of the brainstem, right temporal lobe, and basal ganglia. Digital subtraction angiography confirmed a high-flow direct CCF and revealed a hypoplastic second segment of the BVR responsible for the hypertension in inferior striate veins and venous congestion. Endovascular treatment was performed on an emergency basis. One month after treatment, the patient's symptoms and MRI signal abnormalities almost totally disappeared.

Basal ganglia and brainstem venous congestion may occur in traumatic CCF in cases of a hypoplastic or agenetic second segment of the BVR and may provoke emergency treatment.

Abbreviations used in this paper:BG = basal ganglia; BVR = basal vein of Rosenthal; CCF = carotid-cavernous fistula; DSA = digital subtraction angiography; ICA = internal carotid artery; SPS = superior petrosal sinus; SWAN = susceptibility-weighted angiography; TOF = time of flight.

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Contributor Notes

Address correspondence to: Frédéric Clarençon, M.D., Department of Neuroradiology, Pitié-Salpêtrière Hospital, 47 Blvd de l'Hôpital, Paris 75013, France. email: fredclare5@msn.com.

Please include this information when citing this paper: published online February 14, 2014; DOI: 10.3171/2014.1.JNS132016.

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