Spontaneous Resolution of an Indirect (Dural) Carotid Cavernous Fistula Following Pregnancy: A Case Report
Keywords:
Dural arteriovenous fistula, indirect carotid–cavernous fistula, postpartum ophthalmopathy, vascular disorder.Abstract
Introduction: Indirect (dural) carotid–cavernous fistula (CCF) is the most common dural arteriovenous communication. Pregnancy is a recognized precipitating factor, as hormonal and hemodynamic changes in late pregnancy or at delivery can trigger fistula formation. However, the occurrence of CCF after delivery is rare, with only a few cases reported in the literature.
Case Presentation: 25-year-old woman developed left eye redness, pain, proptosis, tearing, and progressive visual blurring starting one week postpartum after a pre-eclamptic cesarean delivery at 33–34 weeks. Examination revealed left eye visual acuity 6/20, elevated intraocular pressure, eyelid edema, conjunctival hyperemia, chemosis, and tortuous “corkscrew” vessels. Fundus examination showed disc hyperemia and retinal vein dilation. No ocular bruit was detected. Imaging with CT angiography demonstrated a left internal carotid artery–cavernous sinus shunt.
Discussion: Indirect CCF may mimic orbital inflammatory disorders, making early recognition challenging. Digital subtraction angiography (DSA) remains the gold standard for diagnosis. Management depends on flow and symptom severity: low-flow dural fistulas may resolve spontaneously or with manual carotid compression, whereas high-flow or symptomatic fistulas typically require endovascular embolization with neurosurgeon.
Conclusion: Pregnancy-related hormonal and hemodynamic changes can precipitate indirect dural CCF. While embolization is the mainstay of therapy, low-flow fistulas may close conservatively. Early detection, prompt imaging, and multidisciplinary follow-up are essential to preserve vision and optimize outcomes.
