白袍恐懼症

Carotid-cavernous fistula

(1)   特徵：Unilateral Pulsating Exophthalmos

(2)   Classification:

1.      Direct type: high flow，主要發生在頭部外傷後，因為內頸動脈破裂，血液直接進入海綿竇所造成。

2.      Indirect type: low flow，又稱dural type：可為自發性發生，是因為分支腦膜血管裂孔，血液流入海綿竇所造成。

(3)   Classification depending on the type of arterial supply

Type A -Fistulous supply from the internal carotid artery

Type B -Supply from the dural branches of internal carotid artery

Type C- Supply from the dural branches of external carotid artery

Type D -Combined forms

(4)   Direct type介紹

1.      After head injury 1~2 months

2.      屬於AVM，血流堆積在ophthalmic vein，造成眼球充血外凸(proptosis, chemosis, and scleral edema)

3.      Ear可以聽到脈動

4.      嚴重時可併發青光眼、角膜炎、視網膜及視神經的缺血，並造成視力受損(未接受治療的患者約有90%會失明)。

(5)   Diagnosis

MRI scan with MRA/MRV, CT angiogram and a cerebral DSA

(6)   Treatment

balloon embolisation via a catheter in the internal carotid artery

PS. Cavernous內含

internal carotid artery, CN3,4,5-1,6