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Park S, Ku I, Park JU. Neglected Superior Ophthalmic Vein Enlargement before Delayed Symptom of Carotid-Cavernous Fistula in a Blowout Fracture: A Case Report and Literature Review. Arch Plast Surg 2024; 51:397-401. [PMID: 39034982 PMCID: PMC11257734 DOI: 10.1055/a-2258-2586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 01/28/2024] [Indexed: 07/23/2024] Open
Abstract
Carotid-cavernous fistula (CCF) is a rare condition. However, it should be suspected when there are traumatic facial fractures, because if not diagnosed, it can lead to permanent damage such as blindness. Traumatic CCF often presents delayed symptoms, and delayed diagnosis without prompt treatment can lead to permanent injuries in optic and cranial nerves III, IV, V, and VI as well as intracranial hemorrhage. The routine initial modality for patients with suspected facial bone fractures is noncontrast computed tomography (CT) to identify any fracture lines and check for intracranial hemorrhage. We report a post-traumatic CCF case with a 4-day symptom delay, where left superior ophthalmic vein (SOV) enlargement was observed on the routine noncontrast facial CT with ipsilateral orbital wall fracture. When the patient first presented to the emergency room (ER), we did not detect vein enlargement on CT. Afterwards, the patient developed delayed symptoms of CCF and was readmitted to the ER. When we reanalyzed the first CT scan, an enlarged SOV was confirmed. The diagnosis was confirmed via magnetic resonance imaging angiography, and the patient was successfully treated with embolization of the fistula. Thus, we recommend reviewing ophthalmic vein enlargement that is readily identifiable through noncontrast CT for patients injured by craniofacial trauma to suspect the presence of delayed CCF at their initial presentation.
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Affiliation(s)
- Sunkyu Park
- Department of Plastic and Reconstructive Surgery, Seoul National University Boramae Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Inhoe Ku
- Department of Plastic and Reconstructive Surgery, Seoul National University Boramae Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Ji-Ung Park
- Department of Plastic and Reconstructive Surgery, Seoul National University Boramae Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
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Selçuk H, Oray N, Mert RM, Odaman H, Güleryüz H. Evaluation of Missed Radiological Diagnosis in Multiple Trauma Patients With Full-Body Computed Tomography in the Emergency Department. Cureus 2024; 16:e51621. [PMID: 38318559 PMCID: PMC10839344 DOI: 10.7759/cureus.51621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/03/2024] [Indexed: 02/07/2024] Open
Abstract
INTRODUCTION This observational, cross-sectional, and retrospective study was conducted at the Dokuz Eylül University Emergency Department in İzmir, Turkey, after obtaining ethical consent (Dokuz Eylül University Medical Faculty Ethics Committee, approval no. 2019/15-37). In this study, we aimed to determine missed radiological diagnoses and their effects on mortality and morbidity by comparing the ED diagnoses of patients and radiology reports of these patients who presented to the emergency department (ED) with multiple traumas and scanned full-body computed tomography (CT). MATERIALS AND METHODS This observational, cross-sectional, and retrospective study was conducted at the Dokuz Eylül University Emergency Department in İzmir, Turkey. Adult patients who presented to the ED with trauma between July 1, 2016 and June 30, 2018 and who had a full-body CT were included in the study. Radiology reports of CTs and ED electronic file information were compared. Missed diagnoses were determined for all body parts. RESULTS In this study, 1,358 patients who had scanned full-body CT in the ED were evaluated. A total of 369 diagnoses were missed in 248 (18.3%) of the patients. The diagnosis-to-patient ratio was 0.27. In the process of individually evaluating pathological diagnoses in all body regions, it was low only in brain edema, pneumomediastinum, bladder injury, and mesentery injury. At least, there was one missed diagnosis in 88 (9.7%) of 907 (66.8%) discharged patients. At least, there was one missed diagnosis in 18/23 (78.3%) patients who died within the first 48 hours. Among the patients who have missed diagnosis, the rate of the discharged patients was 35.5%, patients called back from home was 1.2%, intensive care unit admission was 20.2%, hospitalization was 65.7%, and death was 8.9%. Among the patients who did not have missed diagnosis, the rates were 73.8%, 0%, 5%, 26.9%, and 0.8%, respectively. CONCLUSION Thoracic region pathologies are the most frequently missed pathologies, and orthopedics was the most frequently consulted department related to the missed diagnoses. Patients who have a missed diagnosis had lesser discharging from the ED than the other patients and had higher rates of in-hospital deaths, hospitalization, and intensive care unit admission.
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Affiliation(s)
- Hakan Selçuk
- Emergency Department, Babaeski State Hospital, Kırklareli, TUR
| | - Nese Oray
- Emergency Medicine, Dokuz Eylül University Faculty of Medicine, Izmir, TUR
| | - Recep M Mert
- Emergency Medicine, Dokuz Eylül University Hospital, Izmir, TUR
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Lindberg MA, Moy Martin EM, Marion DW. Military Traumatic Brain Injury: The History, Impact, and Future. J Neurotrauma 2022; 39:1133-1145. [PMID: 35451333 PMCID: PMC9422790 DOI: 10.1089/neu.2022.0103] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
This review examines how lessons learned from United States military conflicts, beginning with the United States Civil War through the engagements in Iraq and Afghanistan, have shaped current traumatic brain injury (TBI) care in the United States military, influenced congressional mandates and directives, and led to best practices in caring for the warfighter. Prior to the most recent war, emphasis was placed on improving the surgical and medical care of service members (SM) with severe and especially penetrating brain injuries. However, during the Iraq and Afghanistan conflicts, also known as the Global War on Terrorism (GWOT), blast injury from improvised explosive devices most often caused mild TBI (mTBI), an injury that was not always recognized and was labelled the "signature wound" of the GWOT. This has led to extensive research on objective diagnostic technologies for mTBI, the association of mTBI with post-traumatic stress disorder (PTSD), and the long term consequences of mTBI. Here we summarize the key findings and most important advances from those efforts, and discuss the way forward regarding future military conflicts.
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Affiliation(s)
- Megan A. Lindberg
- Traumatic Brain Injury Center of Excellence, Silver Spring, Maryland, USA
- Credence Management Solutions, LLC, Vienna, Virginia, USA
| | | | - Donald W. Marion
- Traumatic Brain Injury Center of Excellence, Silver Spring, Maryland, USA
- General Dynamics Information Technology, Fairfax, Virginia, USA
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Loggini A, Kass-Hout T, Awad IA, El Ammar F, Kramer CL, Goldenberg FD, Lazaridis C, Mansour A. Case Report: Management of Traumatic Carotid-Cavernous Fistulas in the Acute Setting of Penetrating Brain Injury. Front Neurol 2022; 12:715955. [PMID: 35222224 PMCID: PMC8879509 DOI: 10.3389/fneur.2021.715955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Accepted: 11/22/2021] [Indexed: 12/02/2022] Open
Abstract
Traumatic carotid-cavernous fistulas (tCCFs) after penetrating brain injury (PBI) have been uncommonly described in the literature with little guidance on optimal treatment. In this case series, we present two patients with PBI secondary to gunshot wounds to the head who acutely developed tCCFs, and we review the lead-up to diagnosis in addition to the treatment of this condition. We highlight the importance of early cerebrovascular imaging as the clinical manifestations may be limited by poor neurological status and possibly concomitant injury. Definitive treatment should be attempted as soon as possible with embolization of the fistula, flow diversion via stenting of the fistula site, and, finally, vessel sacrifice as possible therapeutic options.
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Affiliation(s)
- Andrea Loggini
- Neurosciences Intensive Care Unit, Department of Neurology, University of Chicago Medicine and Biological Sciences, Chicago, IL, United States
| | - Tareq Kass-Hout
- Neurosciences Intensive Care Unit, Department of Neurology, University of Chicago Medicine and Biological Sciences, Chicago, IL, United States
- Section of Neurosurgery, Department of Surgery, University of Chicago Medicine and Biological Sciences, Chicago, IL, United States
| | - Issam A. Awad
- Neurosciences Intensive Care Unit, Department of Neurology, University of Chicago Medicine and Biological Sciences, Chicago, IL, United States
- Section of Neurosurgery, Department of Surgery, University of Chicago Medicine and Biological Sciences, Chicago, IL, United States
| | - Faten El Ammar
- Neurosciences Intensive Care Unit, Department of Neurology, University of Chicago Medicine and Biological Sciences, Chicago, IL, United States
| | - Christopher L. Kramer
- Neurosciences Intensive Care Unit, Department of Neurology, University of Chicago Medicine and Biological Sciences, Chicago, IL, United States
- Section of Neurosurgery, Department of Surgery, University of Chicago Medicine and Biological Sciences, Chicago, IL, United States
| | - Fernando D. Goldenberg
- Neurosciences Intensive Care Unit, Department of Neurology, University of Chicago Medicine and Biological Sciences, Chicago, IL, United States
- Section of Neurosurgery, Department of Surgery, University of Chicago Medicine and Biological Sciences, Chicago, IL, United States
| | - Christos Lazaridis
- Neurosciences Intensive Care Unit, Department of Neurology, University of Chicago Medicine and Biological Sciences, Chicago, IL, United States
- Section of Neurosurgery, Department of Surgery, University of Chicago Medicine and Biological Sciences, Chicago, IL, United States
| | - Ali Mansour
- Neurosciences Intensive Care Unit, Department of Neurology, University of Chicago Medicine and Biological Sciences, Chicago, IL, United States
- Section of Neurosurgery, Department of Surgery, University of Chicago Medicine and Biological Sciences, Chicago, IL, United States
- *Correspondence: Ali Mansour
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Abstract
Traumatic carotid-cavernous sinus fistula (TCCF) is a rare but significant vascular abnormality in the skull base found after craniomaxillofacial trauma. Although the direct type is usually caused by trauma, the onset of symptoms in TCCF may present several weeks after injury. We present the case of a patient who sustained a blunt head injury from falling down and was hospitalized with skull base fracture associated with zygomatic complex fractures on the right side. After surgery, the recovery was uneventful and the patient was discharged without any problems. On the eighth week postoperatively, the patient returned to hospital presenting tinnitus, bruit on the right orbital area, diplopia, eye pain, and headache. The patient also had severe limitation of ocular movement on lateral gaze. After having brain angio-CT, which showed a dilated superior ophthalmic vein, the diagnosis of CCF with cranial nerve VI was confirmed. The fistula was occluded successfully by using coils. After the procedure, tinnitus, bruit, and headache were reduced immediately. On following up 4 months after coiling, cranial nerve VI palsy and related symptoms-diplopia and limit of ocular movement-were improved significantly. Although TCCFs usually manifest symptoms early after trauma, in this case, the patient presented clinical signs 8 weeks post-injury, while the longest time that was acknowledged in another previously released article was 6 weeks. According to this case, we recommend a careful follow-up until 2 months for patients with skull base fracture in order to rule out the risk of CCF.
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Wang Y, Pan L, Fan W, Zhou Z, Zhu L, Wang Y, Hu R. Influence of vagal injury on acute traumatic reaction after blast injury. Eur J Trauma Emerg Surg 2013; 39:385-92. [PMID: 26815399 DOI: 10.1007/s00068-013-0277-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2012] [Accepted: 03/12/2013] [Indexed: 10/27/2022]
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Stetler WR, Chaudhary N, Wilson TJ, Pandey AS. Indirect carotid-cavernous fistula following minor head trauma treated with incomplete radiographic endovascular occlusion. BMJ Case Rep 2012; 2012:bcr-03-2012-6004. [PMID: 23008364 DOI: 10.1136/bcr-03-2012-6004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
We report the unusual case of a patient with an indirect carotid-cavernous fistula treated with only partial angiographic embolisation of the fistula; however, by 8 weeks postembolisation, she was found to have both symptomatic and angiographic cure. This case highlights the potential for treating indirect carotid-cavernous fistulas with partial embolisation as a means of achieving angiographic and symptomatic cure by altering flow dynamics to attain spontaneous thrombosis.
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