Traumatic optic atrophy and reversible visual functions after balloon embolization for carotid cavernous fistula

Abstract

Two patients with decreased visual acuity and visual field defects in direct relation with a traffic accident are described. The diagnosis of traumatic optic lesion was made on visual disturbances, visual field defects, VEP and clinical observation. Several months after the onset the signs and symptoms of a direct carotid cavernous fistula occurred. The patients were presented for balloon embolization respectively one and six years after the accident. The embolization which was only partially successful during surgery was followed by spontaneous closure of the shunt. The visual functions gradually improved significantly. Not only direct optic trauma with optic atrophy, but also hypoxia by carotid cavernous fistula (CCF) seemed to be of etiologic importance. The authors' two cases prove that visual impairment owing to hypoxia can recover after years. They recommend to consider hemodynamic causes in every traumatic optic lesion.

Key Words:

• optic nerve trauma
• optic atrophy
• carotid cavernous fistula
• hypoxia
• hemodynamic disturbances