23例颈动脉海绵窦瘘的临床特点分析

目的 分析颈动脉海绵窦瘘(CCFs)的临床特点。方法 回顾性分析1990年1月至2012年10月北京协和医院经数字减影脑血管造影确诊的23例CCFs患者的临床资料。总结其眼部特征、神经系统体征及影像学表现,比较直接型与间接型CCFs的临床特点,分析误诊原因。结果 眼部症状为主要的就诊原因(78.3%)。结膜充血、水肿(78.3%)、眼球突出(69.6%)、眼球运动障碍(56.5%)是最常见的体征。直接型CCFs 13例(56.5%),间接型CCFs 10例(43.5%),前者多有头颅外伤史(61.5%比10.0%)、更易引起颅内血管杂音(69.2%比20.0%)。9例患者曾被误诊,眼压升高、眼红、复视等非特异性表现是常见误诊原因。结论 CCFs的临床表现多样,易导致误诊或漏诊。对于慢性红眼、结膜水肿、突眼及眼球运动障碍的患者,眼科医生应高度警惕CCFs的可能,应详细询问病史、行专科检查并借助影像学技术以明确诊断。

Clinical Features of Carotid-cavernous Sinus Fistulas in 23 Patients

Objective To analyze the clinical features of carotid-cavernous sinus fistulas(CCFs).Methods The medical records of 23 patients with CCFs,which was confirmed by conventional cerebral angiography,in Peking Union Medical College Hospital from January 1990 to October 2012 were retrospectively analyzed.Data including patient characteristics,clinical features on ophthalmic examination,neurological assessment,and imaging study were collected.The differences between the direct and the indirect CCFs were compared,and the reasons for misdiagnoses were analyzed.Results Most patients were presented with ocular symptoms(78.3%).The most common signs were conjunctival injection or chemosis(78.3%),proptosis(69.6%),and ocular motor palsies(56.5%).There were 13(56.5%)direct CCFs and 10(43.5%)indirect CCFs,and a history of encephalic trauma was more frequently reported among the former(61.5%)than the latter(10.0%);also,intracranial vascular murmur was more prevalent in patients with direct CCFs(69.2%vs.20.0%).Nine patients were misdiagnosed as other ocular diseases.Nonspecific clinical symptoms and signs such as chemosis,elevated intraocular pressure,and diplopia were the common causes of the misdiagnoses.Conclusions Misdiagnosis of CCFs remains common due to its diverse clinical manifestations.CCFs should be suspected in patients with refractory red eyes,intraocular pressure elevation,proptosis and/or ophthalmoplegia,and a detailed history-taking,careful physical examination,and adequate imaging may minimize the misdiagnosis.