DR. MINU ANTONY

Dr. BHARGAVI PAWAR

Abstract

A 54 year old male had history of recurrent episodes of protrusion of the right eye with right sided headache and redness over 6 months. He had been diagnosed with a variety of disorders like orbital pseudotumour, thyroid ophthalmopathy, diabetic mononeuropathy and uveitis. All previous CTs and MRI scans showed normal orbital findings, with occasional recti enlargement. Examination showed axial proptosis, congested episcleral vessels and restriction of extra ocular movements. A CT angio was performed followed with digital subtraction angiography ( DSA) and patient was diagnosed with a spontaneous indirect CCF type B. The non -traumatic spontaneous, indirect CCFS are less common and are low flow, dural fistulas. Conservative treatment with carotid compression, failing which, coil embolization of anomalous vessels is the management. Painful, episodic proptosis with normal CT orbit should prompt further investigations like DSA and CT angio to uncover intracranial vascular anomalies.