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Anomalous venous drainage of a plexiform (pial) arteriovenous malformation mimicking an indirect caroticocavernous sinus fistula
  1. D Squirrell1,
  2. P Puri1,
  3. P A Rundle1,
  4. C Romanowski2,
  5. I G Rennie3
  1. 1Department of Ophthalmology, Royal Hallamshire Hospital, Sheffield S10 2JF, UK
  2. 2Department of Radiology
  3. 3University Department of Ophthalmology and Orthoptics, Floor O, Royal Hallamshire Hospital, Sheffield S10 2RX, UK
  1. Correspondence to: Mr P Puri

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We report a case of a 35 year old man who presented with proptosis of the left globe and congested episcleral and retinal veins. We present angiographic evidence to show that the venous engorgement of the left orbit was related to anomalous venous drainage of a previously posteriorly draining parietal arteriovenous malformation (AVM).

Case report

A 35 year old man presented complaining of a 3 month history of a red eye and a 1 month history of progressive swelling and protrusion of the left eye. His only significant past medical history was that of a subarachnoid haemorrhage from an intracranial AVM 7 years previously for which he had undergone stereotactic radiosurgery. Ocular examination revealed a visual acuity of 6/5 in either eye. There was a 5 mm axial displacement of the left globe with normal ocular motility. The proptosis was non-pulsatile, non-reducible, and Valsalva manoeuvre was negative. There was no audible bruit. Anterior segment examination was unremarkable aside from congested episcleral vessels. Examination of the fundus revealed dilated and tortuous retinal veins but a normal arterial system. There was no disc swelling.

A computed tomography (CT) scan of the brain and orbits revealed an AVM in the left primary sensory cortex, proptosis of the left globe and …

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