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Br J Ophthalmol 2004;88:311 doi:10.1136/bjo.2003.026575
  • Letter

Magnetic resonance angiography source images in carotid cavernous fistulas

  1. J C Rucker1,
  2. V Biousse2,
  3. N J Newman3
  1. 1Departments of Neurology and Ophthalmology, Case Western Reserve School of Medicine, Cleveland, OH, USA
  2. 2Departments of Ophthalmology and Neurology, Emory University School of Medicine, Atlanta, GA, USA
  3. 3Departments of Ophthalmology, Neurology, and Neurological Surgery, Emory University School of Medicine, Atlanta, GA, USA
  1. Correspondence to: Dr Newman Neuro-ophthalmology Unit, Emory Eye Center. 1365-B Clifton Rd, NE Atlanta, GA 30322, USA; ophtnjnemory.edu
  • Accepted 1 June 2003

Several investigations, including magnetic resonance imaging (MRI), computed tomography (CT), and orbital ultrasound are used to non-invasively screen for carotid cavernous fistula (CCF), with variable results. Examination of magnetic resonance angiography (MRA) source images, in addition to the conventional MRA reconstructions, is now also recognised as a useful method of detecting CCF.1 The finding of a hyperintense signal in the cavernous sinus on MRA source imaging provides additional, and sometimes the only, neuroradiographic CCF evidence. We present this patient to familiarise the ophthalmologist with the typical CCF appearance on MRA source images.

Case report

A 59 year old woman with a left eye pressure sensation and a four year history of left ear pulse-synchronous “buzzing” was found to have elevated left intraocular pressure (26 mmHg) on routine examination. She denied diplopia, visual blurring, or pain. Visual acuity …

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