A successful treatment of spontaneous carotid cavernous fistula causing hemorrhagic infarction treated by detachable balloon

A rare case of hemorrhagic infarction associated with carotid-cavernous fistula is reported. The patient was a 74-year-old female. CT scan showed hemorrhagic infarction of the left superior temporal gyrus, irregular vascular enhancement of the bilateral front-temporal lobe, and dilatation of the cavernous sinus. Left carotid angiogram revealed a high-flow left-sided CCF, cross filling to the right cavernous sinus, and intracavernous aneurysm. Bilateral front-temporal cortical veins were visualized early in the arterial phase. In this case, there was a direct shunt between the internal carotid artery and the cavernous sinus, and venous hypertension. Therefore urgent treatment using detachable balloon catheters was performed. Postoperative digital subtraction angiography revealed the disappearance of CCF. In conclusion, in CCF with cortical venous drainage there is a high possibility of developing hemorrhagic infarction. Only immediate detachable balloon occlusion can improve the outcome in elderly patients.