Eye movements that coincide with the pulse
Introduction
Introduction Eyeball beating consistent with the pulse is one of the symptoms of direct carotid cavernous fistula. Direct carotid cavernous sinus fistula is more common in trauma, and a few direct carotid cavernous sinus fistulas are spontaneous, mostly due to aneurysm rupture of the cavernous sinus segment of the internal carotid artery, which is indistinguishable from traumatic angiography. .
Cause
Cause
Cause:
(1) Causes of the disease:
Excluding the injury is the main cause of the disease, the cause of spontaneous carotid cavernous fistula is:
1. Abnormal arterial wall: muscle fiber dysplasia and Ehlers-Danlos syndrome or elastin pseudo-xanthoma are prone to spontaneous carotid cavernous fistula, patients with Ehlers-Danlos syndrome, collagen loss caused by arterial tortuosity, increased vascular fragility, It often causes difficulties in the diagnosis and treatment of the transarterial route, and osteogenesis imperfecta also increases the vascular fragility, leading to the spontaneous carotid cavernous fistula.
2. Inflammation: Cases of spontaneous carotid cavernous fistula caused by syphilis and fungal arteritis are also reported in the literature.
(2) Pathogenesis:
The main pathogenesis of carotid cavernous fistula is as follows:
1. Stealing blood: The internal carotid artery blood flows directly into the cavernous sinus through the fistula. The blood flow velocity and blood flow of the internal carotid artery are significantly increased, and it is positively correlated with the size of the fistula. A large amount of blood flows into the cavernous sinus and causes the distal end of the internal carotid artery. Insufficient blood supply, cerebral ischemia and ocular arterial insufficiency; the higher the blood flow of the mouth, the greater the amount of blood stealing, the more urgent the course of the disease, the more severe the symptoms, when the mouth is small, the blood stealing is small, the Willis cerebral artery ring When the traffic is good, the course of the disease is slow and the symptoms are mild or not obvious.
2. Drainage vein dilation and congestion: The cavernous sinus has extensive traffic with the surrounding veins, and a large amount of carotid blood directly enters the cavernous sinus, causing high expansion, arterialization and congestion of these veins, and different symptoms due to different venous drainage. The most common way of drainage is to flow into the eyelids through the supraorbital vein, causing pulsating exophthalmos, periorbital venous engorgement, fundus venous congestion, optic disc edema, conjunctival hyperemia, extraocular muscle insufficiency paralysis, etc. Second, when blood When the flow is backward through the inferior sinus, transverse sinus and sigmoid sinus, the eye symptoms are mild and the intracranial noise can be obvious; when the blood flows upward through the sphenoid sinus into the lateral fissure vein, cortical vein and superior sagittal sinus, Intracranial venous dilatation and increased intracranial pressure or even subarachnoid hemorrhage; blood flow down the skull base to the sulcus, can cause nasopharynx vein dilatation, leading to nosebleeds; in addition, if the blood flow to the inside Drainage can also cause contralateral symptoms through the intersponge sinus.
3. Bleeding: carotid cavernous fistula with dural vascular malformation or excessive dilatation of venous rupture caused by intracranial hemorrhage; continuous retinal vein rupture caused by retinal vein rupture affects vision; nasal and nasopharynx venous dilatation causes nasal bleeding.
Examine
an examination
Related inspection
Eye function examination ophthalmology examination
diagnosis:
1. Headache: more common in the early stage, the pain is located in the eyelid area, and the headache will gradually decrease as the disease progresses.
2. Intracranial murmur: almost every case, murmurs such as machine roaring continuous, especially at night and quiet, often make the patient unbearable, irritability, severely affect rest and sleep, auscultation in the affected side of the eyelid, On the forehead, the external ear mastoid, the ankle, or even the entire head, hear a rhythmic murmur consistent with the heart rate; pressing the common carotid artery on the affected side, the noise is reduced or disappeared, and the compression of the contralateral common carotid artery does not disappear or even louder. .
3. Pulsating eye: The eyeball of the affected side protrudes forward and has an eyeball that is consistent with the pulse. The eyeball is caused by congestion and edema of the tissue inside the eye. Touching the eyeball can feel the pulsation of the eyeball and the vibration of the blood flowing. sense.
4. Conjunctival hyperemia and edema: In the affected eyelid, intraocular fistula, conjunctiva, retina and other parts of the venous engorgement congestion, edema, severe conjunctiva over the eyelids, eyelid closure difficulties and exposed keratitis.
5. Eye movement disorders: Insufficient palsy in the affected side of the eye can be accompanied by diplopia, and common paralysis is common.
Pulsating exophthalmos, intracranial murmur, conjunctival hyperemia and edema, nasal bleeding and other clinical manifestations combined with a history of head trauma, diagnosis of this disease is not difficult, skull CT and MRI showed ocular protrusion and intraocular venous or intracranial drainage vein Thickening and accompanying brain tissue edema, TCD and SPECT have the above changes are helpful for diagnosis, and cerebral angiography is the most important means of diagnosis. Both internal carotid artery and vertebral artery angiography must be performed routinely. External angiography, in order to facilitate a clear diagnosis of carotid cavernous fistula blood supply and drainage of the vein.
Diagnosis
Differential diagnosis
The head rotates faster than the eye movement when looking at fast moving objects: The typical manifestation of pediatric ataxia telangiectasia syndrome is that when the patient looks at a fast moving object, the head rotates faster than the eye movement.
Eyeball convergence function paralysis or paralysis: more common in the pineal somatic tumor eye, in addition to the eye can not be seen, but also accompanied by changes in pupillary photoreaction, eyeball convergence function paralysis or paralysis, nystagmus. The damage around the aqueduct (including the front of the aqueduct and the posterior part of the third ventricle) is impaired.
The eyeball regulation function is reduced or disappeared: the eyeball, like the brain, is an organ rich in nerves and blood vessels, and bears extremely complex physiological functions. In order to see the close range of the target, the intraocular lens-ciliary muscle contraction increases the curvature of the intraocular lens, thereby enhancing the refractive power of the eye, so that close objects can form a clear image on the retina. The function of changing the refractive power of the eye while seeing the near object is called the eye's adjustment function. Decreased or disappeared eyeball function will reduce vision.
diagnosis:
1. Headache: more common in the early stage, the pain is located in the eyelid area, and the headache will gradually decrease as the disease progresses.
2. Intracranial murmur: almost every case, murmurs such as machine roaring continuous, especially at night and quiet, often make the patient unbearable, irritability, severely affect rest and sleep, auscultation in the affected side of the eyelid, On the forehead, the external ear mastoid, the ankle, or even the entire head, hear a rhythmic murmur consistent with the heart rate; pressing the common carotid artery on the affected side, the noise is reduced or disappeared, and the compression of the contralateral common carotid artery does not disappear or even louder. .
3. Pulsating eye: The eyeball of the affected side protrudes forward and has an eyeball that is consistent with the pulse. The eyeball is caused by congestion and edema of the tissue inside the eye. Touching the eyeball can feel the pulsation of the eyeball and the vibration of the blood flowing. sense.
4. Conjunctival hyperemia and edema: In the affected eyelid, intraocular fistula, conjunctiva, retina and other parts of the venous engorgement congestion, edema, severe conjunctiva over the eyelids, eyelid closure difficulties and exposed keratitis.
5. Eye movement disorders: Insufficient palsy in the affected side of the eye can be accompanied by diplopia, and common paralysis is common.
Pulsating exophthalmos, intracranial murmur, conjunctival hyperemia and edema, nasal bleeding and other clinical manifestations combined with a history of head trauma, diagnosis of this disease is not difficult, skull CT and MRI showed ocular protrusion and intraocular venous or intracranial drainage vein Thickening and accompanying brain tissue edema, TCD and SPECT have the above changes are helpful for diagnosis, and cerebral angiography is the most important means of diagnosis. Both internal carotid artery and vertebral artery angiography must be performed routinely. External angiography, in order to facilitate a clear diagnosis of carotid cavernous fistula blood supply and drainage of the vein.
