Obstruction of the superior ophthalmic vein assessed by the colour Doppler imaging technique — value in differential diagnostics

We describe a case of a patient with a syndrome of paradoxical worsening of a dural-sinus cavernous arteriovenous malformation which was an iatrogenic consequence of previous embolization of the basal branches of a dural shunt with Yvalon. It is presumed that the thrombogenousYvalon reached the basal branches of the medial meningeal artery of the superior ophthalmic vein, where it caused a complete thrombosis. The compromised ocular and orbital venous outflow caused a dramatic worsening of the ocular congestive symptoms: venous stasis retinopathy with dilated veins, flame and dot-shaped hemorrhages and secondary increase in intraocular pressure. The diagnosis of thrombosis of the entire superior ophthalmic vein was confirmed by color Doppler imaging. The pathomechanism is discussed. Although the ocular pathology is usually self-limiting after establishment of the collateral venous outflow channels, because of serious congestive ocular symptoms, argon laser photocoagulation and conservative antiglaucomatous local therapy were applied. In this patient, shortly after establishing the orbital collateral venous draining channels, the ocular symptoms improved. There was no other complication during the one-year follow-up.