Swollen and bloodshot eye following headache

Chia Cheng Hsu, Shih Hung Tsai, Jen Chun Wang, Hung Wen Kao, Chin Wang Hsu, Wei Hsiu Liu, Sy Jou Chen

Research output: Contribution to journalArticle

Abstract

A ruptured cavernous carotid aneurysm (CCA) with carotid cavernous fistula can appear as a benign headache but progress to a swollen and bloodshot eye overnight. A 66-year-old woman visited emergency department with sudden onset of pain behind her left forehead and vomiting. She was treated for a migraine-like headache and discharged. She presented again on the next day with a persistent headache and a swollen left eye with blurred vision. An ophthalmologic examination revealed erythema of the left lid and chemosis at the temporal and lower bulbar conjunctiva. A cranial nonenhanced computed tomography (CT) scan had been performed at her previous visit. The scan exhibited a nodular mass lesion involving the left cavernous sinus. CT angiography was subsequently used to determine that the lesion was a giant aneurysm in the left cavernous internal carotid artery, causing enlargement of the left ophthalmic veins. The symptoms of her left eye rapidly progressed to severe chemosis, edematous change over periocular region, and limited movements after 8 h. The patient received emergent lateral canthotomy and inferior cantholysis to avoid acute orbital compartment syndrome and was subsequently treated with stent-assisted coil embolization. A ruptured CCA is an urgent condition that requires rapid assessment of both cranial vascular and ocular lesions. A history of sudden onset headache with a nonpainful acute unilateral red eye may serve as a clue to prompt additional diagnostic studies and ophthalmologist evaluation. Adequate radiological studies and early endovascular intervention can reduce the likelihood of permanent ocular injury and vision impairment.

Original languageEnglish
JournalAmerican Journal of Emergency Medicine
DOIs
Publication statusAccepted/In press - Jan 1 2018

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Headache
Aneurysm
Eye Injuries
Compartment Syndromes
Cavernous Sinus
Forehead
Conjunctiva
Internal Carotid Artery
Erythema
Migraine Disorders
Fistula
Vomiting
Stents
Blood Vessels
Hospital Emergency Service
Veins
Tomography
Pain

ASJC Scopus subject areas

  • Emergency Medicine

Cite this

Hsu, C. C., Tsai, S. H., Wang, J. C., Kao, H. W., Hsu, C. W., Liu, W. H., & Chen, S. J. (Accepted/In press). Swollen and bloodshot eye following headache. American Journal of Emergency Medicine. https://doi.org/10.1016/j.ajem.2018.11.008

Swollen and bloodshot eye following headache. / Hsu, Chia Cheng; Tsai, Shih Hung; Wang, Jen Chun; Kao, Hung Wen; Hsu, Chin Wang; Liu, Wei Hsiu; Chen, Sy Jou.

In: American Journal of Emergency Medicine, 01.01.2018.

Research output: Contribution to journalArticle

Hsu, Chia Cheng ; Tsai, Shih Hung ; Wang, Jen Chun ; Kao, Hung Wen ; Hsu, Chin Wang ; Liu, Wei Hsiu ; Chen, Sy Jou. / Swollen and bloodshot eye following headache. In: American Journal of Emergency Medicine. 2018.
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