Spontaneous carotid cavernous fistula in young female with anti-thrombin III deficiency

A 27-year-old female patient presented with headache, vomiting, and visual disturbances who was evaluated and detected to have a direct carotid cavernous fistula (CCF). Secondary causes were ruled out, and she was treated with coil occlusion and glue injection. A month after almost complete clinical recovery, she developed deep vein thrombosis of left thigh. Subsequent work-up revealed antithrombin III (ATIII) deficiency in her. To the best of our knowledge, this is the first reported case of ATIII deficiency associated with CCF. This case shows the importance of working up for a primary etiology if any, to prevent further complications after surgery.

Key-words:

Antithrombin III deficiency - carotid cavernous fistula - deep vein thrombosis - sinus thrombosis

• References

• 1 Kim CK, Shin JY, Chang JY, Lee SH. Spontaneous carotid cavernous fistula in a case with Protein S deficiency that newly developed ophthalmoplegia after embolization. J Clin Neurol 2011;7:164-7.
• 2 Kojima T, Miyachi S, Sahara Y, Nakai K, Okamoto T, Hattori K, et al. The relationship between venous hypertension and expression of vascular endothelial growth factor: Hemodynamic and immunohistochemical examinations in a rat venous hypertension model. Surg Neurol 2007;68:277-84.
• 3 Preter M, Tzourio C, Ameri A, Bousser MG. Long-term prognosis in cerebral venous thrombosis. Follow-up of 77 patients. Stroke 1996;27:243-6.
• 4 Gerlach R, Boehm-Weigert M, Berkefeld J, Duis J, Raabe A, Seifert V, et al. Thrombophilic risk factors in patients with cranial and spinal dural arteriovenous fistulae. Neurosurgery 2008;63:693-98.
• 5 Izumi T, Miyachi S, Hattori K, Iizuka H, Nakane Y, Yoshida J, et al. Thrombophilic abnormalities among patients with cranial dural arteriovenous fistulas. Neurosurgery 2007;61:262-8.