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Abstract Details

Evaluating the Incidence and Neuro-Ophthalmic Manifestations of Carotid-Cavernous Fistulas
Neuro-ophthalmology/Neuro-otology
P4 - Poster Session 4 (5:30 PM-6:30 PM)
5-012
To determine the incidence of carotid-cavernous fistula (CCF) and describe the neuro-ophthalmic manifestations.
CCF is a potentially life and vision threatening condition.  There are no previously published population-based studies on the incidence.

We retrospectively identified adult Olmsted County patients over 18 years of age who were diagnosed with CCF from January 1, 1970 through August 31, 2019 using the Rochester Epidemiology Project (REP), which is a record-linkage system of medical records for all patient-physician encounters among Olmsted County, Minnesota residents. Charts were reviewed for ophthalmic signs and symptoms, including conjunctival chemosis, proptosis, ocular bruit, diplopia, ophthalmoplegia, orbital pain, and vision loss. We also determined the number of patients with CCF found incidentally on neuroimaging, without clinical manifestations.

There were eleven patients diagnosed with CCF between January 1, 1970 and August 31, 2019 in Olmsted County, an overall incidence rate of 0.193 per 100,000 with a 95% CI of (0.096, 0.346). The median age was 49 years (range 23-74 years) and 54.5% were female. Three (27.2%) patients were asymptomatic and found incidentally on imaging that was obtained for unrelated causes and one patient could not be evaluated because she passed away from severe head trauma. The following neuro-ophthalmologic or ocular manifestations were identified in the remaining 7 patients: 6 cranial nerve VI palsy, 2 cranial nerve III palsy, 6 chemosis/conjunctival injection, 4 proptosis, 2 audible bruit, 1 vision loss, and 1 facial numbness. Of those patients with symptomatic fistulas, all underwent obliteration, except for one that spontaneously resolved. 

This is the first study to provide a population-based incidence of CCF, which supports the notion that it is a rare condition.  Neuro-ophthalmic manifestations are common, especially chemosis/conjunctival injection and cranial VI palsy.  However, a third of patients with CCF can be asymptomatic and found incidentally on imaging.
Authors/Disclosures
Devon Cohen, MD (Cleveland Clinic)
PRESENTER 		No disclosure on file
M. Tariq Bhatti, MD (Kaiser Permanente, Northern California) Dr. Bhatti has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Receptos . Dr. Bhatti has received personal compensation in the range of $0-$499 for serving on a Scientific Advisory or Data Safety Monitoring board for NIH LHON gene therapy study .
John Chen John Chen has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for UCB. John Chen has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Amgen. John Chen has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for UCB.