According to Dr. Duong Dinh Hoan, Head of the Neuro-Intervention Unit at the Center for Diagnostic Imaging and Interventional Radiology, Tam Anh General Hospital TP HCM, cavernous sinus dural arteriovenous fistula (CSDAVF) typically affects women in their 50s to 60s or individuals with a history of head trauma. This condition is uncommon in younger women, especially following pre-eclampsia during pregnancy. Without timely treatment, patients face risks including vision loss, cerebral hemorrhage, stroke, and even life-threatening complications.

Doctors believe Ms. Thuyen likely developed the brain vascular fistula during pregnancy due to pre-existing conditions such as hypertension, diabetes, and dyslipidemia, which weakened her blood vessel walls. Pre-eclampsia, combined with hemodynamic changes and altered blood flow during pregnancy, can rupture small blood vessels in the cavernous sinus, creating an abnormal fistula between the carotid artery and the cavernous sinus.

Before childbirth, Ms. Thuyen was diagnosed with orbital cellulitis; her condition worsened 10 days postpartum. Dr. Le Thi Thanh Hai, from the High-Tech Eye Center, Tam Anh General Hospital TP HCM, noted Ms. Thuyen's left eye vision was 3/10. Despite no history of head trauma, she had recently experienced severe pre-eclampsia. Doctors suspected a lesion behind her eye socket, and a brain MRI revealed a left cavernous sinus dural arteriovenous fistula.

Ms. Thuyen's left eye before (left) and one day after (right) the intervention. Photo: Tam Anh General Hospital

Dr. Hoan and his team performed an endovascular intervention on Ms. Thuyen using a digital subtraction angiography (DSA) system. They utilized metal coils and embolization materials to completely seal the abnormal fistula.

Following the intervention, DSA images confirmed the fistula was completely treated, cerebral circulation stabilized, and no complications arose. One day after the procedure, Ms. Thuyen's eye protrusion and redness decreased, and her left eye vision recovered to 8/10. She will continue to receive regular follow-ups for long-term assessment.

The endovascular intervention team for Ms. Thuyen. Photo: Tam Anh General Hospital

Cavernous sinus dural arteriovenous fistula occurs due to an abnormal connection between the carotid artery and the cavernous sinus. This leads to dilated ophthalmic veins, a sudden increase in intraorbital pressure causing congestion, compression of the optic nerve, and retinal ischemia.

Non-traumatic cases often present only with eye symptoms, making them easily mistaken for conjunctivitis, scleritis, or orbital cellulitis. Symptoms such as persistent red eye, proptosis, blurred vision, or orbital pain should not be ignored, as they can indicate dangerous brain vascular disease, explained Dr. Hai.

Doctors advise pregnant women, especially those with underlying conditions like diabetes, hypertension, or cardiovascular disease, to undergo regular eye examinations and seek prompt medical attention if any unusual eye symptoms appear.

Kim Tham - Hong Tham

*Patient's name has been changed