Game 16
Solve
in
1
You are an optometrist working in a hospital and a patient presents with proptosis, but the lids do not appear to swell too much.
The proptosis from the side appears to pulsate. The conjunctival vessels have a corkscrew like appearance, and the patient looks disoriented, with bleeding out the side of the head.
Solve
in
2
You perform an angiogram. This is what it shows:
Last
chance
Your patient has a history of high blood pressure, but made worse is the fact that they were just in a car crash.
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Your treatment will consist of:
- potential neurosurgery
- lubrication therapy
The
answer
Direct Carotid Cavernous Fistula
- Blockage of the internal carotid artery, revealed through angiography
- Due to the high pressure, it will cause pulsatile proptosis
- Can either be due to a congenital reason (high blood pressure), or exogenous reasons (trauma from car crash etc.)
- Both carotid cavernous fistula will show tortuous corkscrew like conjunctival vessels
- Chemosis is present, but issue can self-result through thrombosis.
- Otherwise, neurosurgery may be required.