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Purpose <p>Direct carotid–cavernous fistulas (CCFs) are rare, high-flow shunts between the cavernous internal carotid artery and cavernous sinus, classified as Barrow Type A lesions. They commonly cause orbital venous congestion and cranial neuropathies, whereas endocrine dysfunction is exceedingly uncommon. We present the first case of a traumatic CCF in a pediatric patient complicated by transient central hypothyroidism, exploring whether severe venous congestion can impair hypothalamic–pituitary perfusion and emphasizing the importance of early vascular imaging and hormonal monitoring.</p> Methods <p>Retrospective review of a 4-year-old female presenting with progressive proptosis, chemosis, elevated intraocular pressure, and central hypothyroidism after facial trauma.</p> Results <p>Initially treated for concussion, the patient developed persistent ocular pain and swelling during a 7-day admission. Delayed CTA&#xa0;demonstrated&#xa0;a direct right ICA–cavernous sinus fistula with bilateral superior ophthalmic vein engorgement and cortical venous reflux. Digital subtraction angiography confirmed a high-flow Barrow Type A CCF caused by cavernous ICA dissection and pseudoaneurysm rupture. Low TSH was observed. Initial&#xa0;transarterial&#xa0;coil embolization reduced shunting but left residual filling. Follow-up angiography showed improved ICA flow and resolution of cortical reflux, though persistent drainage&#xa0;remained. Due to ongoing symptoms, combined transvenous and&#xa0;transarterial&#xa0;embolization achieved near-complete occlusion while preserving carotid patency. At follow-up, complete interval thrombosis was&#xa0;observed&#xa0;with stable ICA, healing pseudoaneurysms, normalized venous drainage, and no recurrent shunting; hypothyroidism resolved at follow-up.</p> Conclusion <p>Early vascular imaging is essential after craniofacial trauma with persistent orbital findings. Multimodal endovascular therapy can restore cavernous circulation and endocrine function while&#xa0;maintaining&#xa0;carotid integrity.</p>

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Central hypothyroidism as a rare sequela of traumatic carotid cavernous fistula in a pediatric patient

  • 期刊论文

  • 发表日期：

    2026年5月4日

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  • Domenico Napoletano,
  • Aaron Higginbotham,
  • Austin Reed,
  • Gabriel LeBeau,
  • Cody Heskett,
  • Jeremy Peterson

摘要

Purpose

Direct carotid–cavernous fistulas (CCFs) are rare, high-flow shunts between the cavernous internal carotid artery and cavernous sinus, classified as Barrow Type A lesions. They commonly cause orbital venous congestion and cranial neuropathies, whereas endocrine dysfunction is exceedingly uncommon. We present the first case of a traumatic CCF in a pediatric patient complicated by transient central hypothyroidism, exploring whether severe venous congestion can impair hypothalamic–pituitary perfusion and emphasizing the importance of early vascular imaging and hormonal monitoring.

Methods

Retrospective review of a 4-year-old female presenting with progressive proptosis, chemosis, elevated intraocular pressure, and central hypothyroidism after facial trauma.

Results

Initially treated for concussion, the patient developed persistent ocular pain and swelling during a 7-day admission. Delayed CTA demonstrated a direct right ICA–cavernous sinus fistula with bilateral superior ophthalmic vein engorgement and cortical venous reflux. Digital subtraction angiography confirmed a high-flow Barrow Type A CCF caused by cavernous ICA dissection and pseudoaneurysm rupture. Low TSH was observed. Initial transarterial coil embolization reduced shunting but left residual filling. Follow-up angiography showed improved ICA flow and resolution of cortical reflux, though persistent drainage remained. Due to ongoing symptoms, combined transvenous and transarterial embolization achieved near-complete occlusion while preserving carotid patency. At follow-up, complete interval thrombosis was observed with stable ICA, healing pseudoaneurysms, normalized venous drainage, and no recurrent shunting; hypothyroidism resolved at follow-up.

Conclusion

Early vascular imaging is essential after craniofacial trauma with persistent orbital findings. Multimodal endovascular therapy can restore cavernous circulation and endocrine function while maintaining carotid integrity.