CC BY-NC-ND 4.0 · Indian J Radiol Imaging 2009; 19(04): 308-310
DOI: 10.4103/0971-3026.57216
Neuroradiology

Case Report: Carotid-cavernous fistula due to aneurysmal rupture in a case of aortoaortitis with bilateral giant internal carotid artery aneurysms

Sandeep Sharma
Department of Neuroradiology, AIIMS, Ansari Nagar, New Delhi - 110 029, India
,
Subhash Kumar
Department of Neuroradiology, AIIMS, Ansari Nagar, New Delhi - 110 029, India
,
Arvind Nanda
Department of Neuroradiology, AIIMS, Ansari Nagar, New Delhi - 110 029, India
,
Edmond Moses
Department of Neuroradiology, AIIMS, Ansari Nagar, New Delhi - 110 029, India
› Author Affiliations

Abstract

Takayasu aortoarteritis (TA) rarely affects the nervous system, but when it does, it usually manifests as cerebral ischemia or stroke. These strokes have mainly been attributed to stenotic extracranial vessels. Stenoses of intracranial vessels, although rare in TA, can occur due to either embolization into the vessel or because of the vasculitic process itself. Intracranial aneurysms are very rare in patients with TA. Bilateral cavernous internal carotid artery (ICA) aneurysms are rarer. They have been reported following radiation therapy and in association with fibromuscular dysplasia and juvenile Paget disease. Bilateral mycotic intracavernous aneurysms also occur. Bilateral giant cavernous ICA aneurysms with carotid-cavernous fistula (CCF) consequent to rupture into the cavernous sinus in a case of TA are extremely unusual. We report a case that fulfilled both American College of Rheumatology and European League against Rheumatology criteria for TA. The patient had bilateral cavernous sinus giant aneurysms and CCF because the right-sided aneurysm had ruptured and was leaking into the cavernous sinus.



Publication History

Article published online:
02 August 2021

© 2009. Indian Radiological Association. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).

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  • References

  • 1 Regina G, Fullone M, Testini M. Aneurysms of the supra-aortic trunks in Takayasu′s disease: Report of two cases. J Cardiovascular Surg 1998;39:757-60.
  • 2 Sueyoshi E, Sakamoto I, Hayashi K. Aortic aneurysms in patients with Takayasu′s arteritis: CT evaluation. AJR 2000;175:1727-33.
  • 3 Tabata M, Kitagawa T, Saito T, Uozaki H, Oshiro H, Miyata T, et al. Extracranial carotid aneurysm in Takayasu′s arteritis. J Vasc Surg 2001;34:739-42.
  • 4 Kanda M, Shinoda S, Masuzawa T. Ruptured vertebral artery-posterior inferior cerebellar artery aneurysm associated with pulseless disease--case report. Neurol Med Chir (Tokyo) 2004;44:363-7.
  • 5 Arsend WP, Michel BA, Bloch DA, Hunder GG, Calabrese LH, Edworthy SM, et al. The American College of Rheumatology 1990 criteria for the classification of Takayasu arteritis. Arthritis Rheum 1990;33:1129-34.
  • 6 Ozen S, Ruperto N, Dillon MJ, Bagga A, Barron K, Davin JC, et al. EULAR/PReS endorsed consensus criteria for the classification of childhood vasculitides. Ann Rheum Dis 2006;65:936-41.
  • 7 Kerr GS, Hallahan CW, Giordano J, Leavitt RY, Fauci AS, Rottem M, et al. Takayasu arteritis. Ann Intern Med 1994;120:919-29.
  • 8 Takano K, Sadoshima S, Ibayashi S, Ichiya Y, Fujishima M. Altered cerebral hemodynamics and metabolism in Takayasu′s arteritis with neurological deficits. Stroke 1993;24:1501-6.
  • 9 Klos K, Flemming KD, Petty GW, Luthra HS. Takayasu′s arteritis with arteriographic evidence of intracranial vessel involvement. Neurology 2003;60:1550-1.
  • 10 Kumral E, Evyapan D, Aksu K, Keser G, Kabasakal Y, Balkir K Microembolus detection in patients with Takayasu′s arteritis. Stroke 2002;33:712-6.
  • 11 Molnar P, Hegedus K. Direct involvement of intracerebral arteries in Takayasu′s arteritis. Acta Neuropathol (Berl) 1984;63:83-6.
  • 12 Weiss PF, Corao DA, Pollock AV, Finkel TH, Smith SE. Takayasu arteritis presenting as cerebral aneurysms in an 18 month old: A case report. Pediatr Rheumatol 2008;6:4.