INCREASED CEREBRAL PERFUSION AFTER DETACHABLE BALLOON EMBOLIZATION OFCAROTID-CAVERNOUS FISTULA ON TECHNETIUM-99M-HMPAO BRAIN SPECT

Most symptoms and signs associated with a carotid cavernous fistula (C CF) are thought to be related to regurgitation of flow into cortical v eins and to venous congestion. Arteriovenous shunting and secondary pe rfusion insufficiency is regarded as less important in causing symptom s. We describe a 27-yr-old male patient who had improvement of neurolo gic symptoms and signs after detachable balloon embolization of trauma tic CCF. The pre- and postocclusion Tc-99m-HMPAO brain SPECT scan show ed improved cerebral blood flow after occlusion. The CCF had shown mar ked arteriovenous shunting without significant venous congestion on pr e-occlusion cerebral angiogram. The postocclusion cerebral angiogram r evealed complete occlusion of the CCF with increased blood flow in the ipsilateral middle cerebral artery distribution. These findings sugge st that cerebral dysfunction may be related to perfusion insufficiency from the CCF. Brain SPECT scanning can assess the functional status o f cerebral perfusion and may be a useful, noninvasive adjunct to angio graphy.