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ORIGINAL ARTICLE
Year : 1983  |  Volume : 31  |  Issue : 4  |  Page : 321-322

Proptosis due to arteriovenous malformations and fistulae


Deptt. of Ophthalmology, Neurosurgery and Radiology, Army Hospital (Research & Referal) Delhi Cantt, India

Correspondence Address:
M S Boparai
Senior Adviser (Ophthalmology), Army Hospital (RR), Delhi Cantt-110010
India
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Source of Support: None, Conflict of Interest: None


PMID: 6677579

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How to cite this article:
Boparai M S, Sharma R C, Roy T K, Sobti V P. Proptosis due to arteriovenous malformations and fistulae. Indian J Ophthalmol 1983;31:321-2

How to cite this URL:
Boparai M S, Sharma R C, Roy T K, Sobti V P. Proptosis due to arteriovenous malformations and fistulae. Indian J Ophthalmol [serial online] 1983 [cited 2020 Oct 24];31:321-2. Available from: https://www.ijo.in/text.asp?1983/31/4/321/27543



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Pulsatile proptosis results from arterio venous malformations and fistulas, aneurys­mal dilatations and vascular tumours within the orbit. Carotid cavernous fistula (CCF) is by far the commonest cause. The present study concerns our experience with pulsatile proptosis in 10 cases.


  Materials and methods Top


10 cases of unilateral proptosis due to carotid cavernous fistula and AV malforma­tion were seen during the last 5 years. Diag­nosis was evident clinically in some cases but carotid angiography was carried out in all. Some of the cases were seen in eye depart­ment due to ocular symptoms and some were seen in neurosurgical division. 6 cases were treated surgically, 2 had spontaneous regression


  Observations Top


Age ranged from 18-55 years. One patient was below 20 years, 6 were in the age group 21-30 years. one in age group 31-50 years and one in 51-60 years. Male, female ratio was 7:3.

Unilateral proptosis was a feature of all cases. No case had bilateral proptosis. Pulsa­tion/bruit was present in 8 cases.

Carotid angiography revealed 7 cases to be having CCF and 3 AV malformations.

6 cases, all males developed the symptoms following trauma; 3 had gun shot injuries and 3 had closed head injury due to road traffic accidents. The time between developing of symptoms and trauma varied from 1-4 weeks. 4 cases. three females and one male had spon­taneous onset. These females developed symptoms towards end of pregnancy; 2 had AV malformation and one CCF. The only male with spontaneous onset was a diabetic and hypertensive aged 55 years.

[Table - 1] shows other ocular symptoms in the 10 cases.


  Discussion Top


Surgical treatment was carried out in 6 cases. In 4 cases. internal carotid ligation was carried out by clipping the artery intracranally distal to the fistula with muscle embolisation of cavernous sinus in one case. In 3 patients proptosis subsided slowly and veins regressed at all sites. Pulsation disappeared soon after surgery. One patient developed hemiparesis of the opposite side which recovered in 4 weeks. One case died due to other effects of gun shot injury. In 2 cases common carotid was ligated in the neck. This failed to cause any regression of proptosis and other symp­toms. Internal carotid ligation was done subsequently in one case in the neck and in the other intracranially. One patient developed signs of ischaemia of the anterior segment and a hypopyon corneal ulcer. In this patient proptosis increased markedly following initial subsidence. The other patient became a symp­tomatic.

In 2 patients fistulas closed spontaneously following carotid angiography. The ap­pearance before angiography and after subsidence of symptoms over a period of 6 weeks. Both patients have shown, no recurrence over a follow up period of one year.


  Summary Top


Carotid cavernous fistulas and AV mal­formations are the commonest cause of pul­satile proptosis. Presentation and manage­ment of 10 cases of proptosis has been dis­cussed. Trauma was responsible for 60° , cases and 40% were spontaneous. 6 cases were treated surgically by ligation of internal carotid artery. Medical treatment has no role though in 2 cases the fistulas closed spontaneously following carotid angiography.



 
 
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