Background: Direct carotid-cavernous fistulas (CCFs) are uncommon but potentially devastating vascular lesions resulting from an abnormal communication between the intracavernous internal carotid artery and the cavernous sinus. Most direct CCFs are traumatic and may lead to progressive visual impairment, cranial nerve dysfunction, and intracranial complications if left untreated.
Case Description: We report the case of a 25-year-old man who developed a high-flow direct carotid-cavernous fistula following craniofacial trauma secondary to physical assault. Clinical examination revealed pulsatile left-sided exophthalmos, orbital bruit, conjunctival congestion, eyelid edema, and severe visual impairment with visual acuity limited to 1/10. Cerebro-orbital computed tomography and digital subtraction angiography confirmed a Barrow type A direct carotid-cavernous fistula arising from the C3 segment of the left internal carotid artery. Endovascular embolization using detachable platinum coils achieved complete angiographic occlusion of the fistula. At six-month follow-up, visual acuity improved to 8/10 with marked regression of orbital symptoms.
Conclusion: Early diagnosis and prompt endovascular intervention remain the cornerstone of management for high-flow traumatic carotid-cavernous fistulas. Endovascular embolization offers excellent angiographic and functional outcomes while minimizing treatment-related morbidity.
World Journal of Advanced Research and Reviews, 2026, 30(03), 492-499
Article DOI: 10.30574/wjarr.2026.30.3.1409
Received on 22 April 2026; revised on 31 May 2026; accepted on 02 June 2026
Objectives: One of the chronic complications associated with β-thalassemia major is bone metabolic disorder. The present study was designed to assess the prevalence of bone metabolic disorders and associated risk factors among the patients.
Methodology: A cross-sectional study was conducted. The study population consisted of major β-thalassemia patients. Levels of several serum elements were measured. Bone mineral density (BMD) of lumbar spine and the neck of the femur were also assessed. All collected data were analyzed to determine the frequency of bone metabolic disorders and the related risk factors.
Results: Fifty-two patients with mean age of 22.46 ±3.36 years entered the study. The mean height of participants was 162.35±9.75 Cm and 21% of them were short stature. Regarding blood biochemical factors, ferritin in 14 (26.9%), 16 (30.8%), and 22 (42.3%) subjects were <1000, 1000-2000, and >2000 ng/ml, respectively. Hypophosphatemia was observed in 28.8% and 3.8% of participants had hypocalcemia. Vit D3 insufficiency was frequently reported in the participants (57.7%). Concerning BMD values, more than 75% of participants showed degrees of bone mineral disorders. Analysis of data showed that sex was a significant factor affecting femur (p=0.003) and spine BMD status (p=0.039). No relationships were observed between BMD status and measured serum elements (p>0.05).
Conclusion: The findings of present study revealed that β-thalassemia patients were at great risk of bone metabolic disorders. Although the results showed no correlations between BMD levels and several blood biochemical factors, β-thalassemia major patients should be monitored for potential blood biochemical imbalance and their associated long-term consequences.
β-thalassemia major; Bone mineral density; Lumbar Vertebra; Femur; Serum; Elements
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Seyed Mohamad Kazem Nourbakhsh, Sareh Shahverdi and Reza Tavakolizadeh. Bone metabolic disorders among patients with major β thalassemia: A cross-sectional study from Iran. World Journal of Advanced Research and Reviews, 2026, 30(03), 492-499. Article DOI: https://doi.org/10.30574/wjarr.2026.30.3.1409