Abstract

A 74 year male came to OPD with complaint of diminution of vision in RE since 8 months. H/o blunt trauma to LE 18 years back following which he developed loss of vision in LE, a/w painless progressive swelling near the nasion and left forehead since 2 years. On examination, a soft, fluctuant swelling measuring 5×3 cmxcm seen, tortuous vessels seen over the forehead with facial asymmetry and 15 exotropia in left eye. VA in RE was HMCF and LE was PL-ve. EOM were normal. Anterior segment showed both eyes mature cataract with LE grade 2 RAPD. On palpation the swelling was reducible, pulsatile with bruit, which disappears with carotid artery compression. USG Colour Doppler showed- Hypoechoic serpiginous vascular channels on the medial aspect of right orbit, left retro orbital region s/o high flow A-V malformation. Diagnostic Cerebral Angiogram showed Type A direct CCF. Patient underwent RE cataract surgery and post op vision was 6/9 and is posted for endovascular embolization of left CCF.