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SEIZURE ON CAROTID CAVERNOUS FISTULA PATIENT

CASE REPORT

Novita Khoirunnisa* Imam Rusdi**
*Neurology Resident, Neurology Department, Faculty of Medicine GadjahMada University
**Neurology Staff, Neurology Department, Faculty of medicineGadjahMada University

ABSTRACT

Background : Carotid Cavernous Fistula (CCF) is one of specific form of arteriovenous
malformation with abnormal part between internal or external carotid artery with cavernous
sinus. The incidence of CCF itself is unknown but around 5-20% between all of intracranial
vascular malformation

Aim : To report a patient with chief complain of seizure and was diagnosed with Carotid
Cavernous Fistula

Description : A 20 year old female came to ER of Sardjitos hospital with chief complain of
grand mal seizure, followed with weakness of the left extremity. Before the seizure, the
patient complained of pulsatile headache. There was history of brain trauma with
intraventrikular hemorrhage and was done shunting to the patient. Based on physical
examination, the patient was in good general appearance, compos mentis, 110/60 mmHg BP,
90x/mnt pulse, 37,2
o
Celcius temperature, 20x/mnt respiration rate. There were multiple
cranial nerves palsy (lesion of right I, II cranial nerves), paralysis of right III, IV, VI cranial
nerves, left hemiparalysis. From head CT, scan there was a carotid cavernous fistula on the
right temporal cortex. From EEG, there were abnormal hypofunctionand irritation with no
focus or asymmetry in brain mapping. Angiography result showed direct type CCF with
stealing phenomenon.

Conclusion : Seizure can be one of clinical manifestation of Carotid Cavernous Fistula,
which was probably caused by cortical irritation of mass effect, disturbance of blood flow
cause deviation of blood flow it self, ischemic or neuronal lesion or microscopic bleeding and
gliosis.

Keywords: Carotid Cavernous Fistula, stealing phenomenon, seizure

BANGKITAN PADA PASIEN DENGAN CAROTI D CAVERNOUS FI STULA

LAPORAN KASUS
Novita Khoirunnisa* Imam Rusdi **
*Residen Neurologi Fakultas Kedokteran Universitas Gajah Mada
**Staf Pengajar Bagian Neurologi Fakultas Kedokteran Universitas Gajah Mada

ABSTRAK

Latar Belakang : Carotid Cavernous Fistule (CCF) adalah salah satu bentuk spesifik
arterivena malformasi, yaitu hubungan abnormal antara arteri carotis internal atau eksternal
dengan sinus cavernosus. Insidensi CCF pada populasi tidak diketahui, namun menduduki 5-
20% malformasi vaskular intrakranial.

Tujuan : untuk melaporkan pasien dengan keluhan utama kejang dan di diagnosa sebagai
carotid cavernous fistule

Deskripsi : Seorang perempuan usia 20 tahun datang ke IGD RSUP dr. Sardjito, dengan
keluhan utama kejang seluruh badan, yang diikut kelemahan gerak sebelah kiri. Sebelum
kejang dikeluhkan nyeri kepala berdenyut. Didapatkan riwayat trauma kepala dengan
perdarahan ventrikel dan dilakukan extra ventrikel drainage. Berdasarkan pemeriksaan fisik
didapatkan kondisi umum yang cukup, kompos mentis, tekanan darah 110/60 mmHg, nadi
90x/menit, suhu 37,2
o
celcius, pernafasan 20x/menit Didapatkan kelumpuhan saraf kranialis
multipel (Lesi nervus I, II dextra (sequele), Parese N. III, IV, VI (D)), hemiparese sinistra.
Dari HCTS didapatkan gambaran carotid cavernous fistula regio temporal dextra, EEG
abnormal hipofungsi dan iritatif di frontal kiri dengan brain mapping tidak ditemukan fokus
maupun asimetri. Hasil angiografi : CCF tipe direct dengan stealing phenomen


Kesimpulan : kejang bisa merupakan manifestasi klinis carotid cavernous fistula, yang
mungkin diakibatkan oleh iritasi kortikal akibat efek massa, gangguan aliran yang
menyebabkan deviasi aliran darah, lesi iskemik dan neuronal atau perdarahan mikroskopik
dan gliosis

Kata kunci: carotid cavernous fistula, stealing phenomen, kejang