Proptosis, congestion, and secondary glaucoma due to carotid-cavernous fistula after embolization

Carotid-cavernous fistulas (CCFs) are traumatic or spontaneously occurring communications between the carotid artery and the cavernous sinus. Carotid-cavernous fistulas can be due to a direct connection or indirect connections between the carotid artery system and the cavernous sinus. According to the etiologic classification, they may be of traumatic or spontaneous origin, and according to the angiography classification, they may be of direct or dural.Most CCFs are of spontaneous origin, and these are reported as frequently self-healing lesions. Spontaneous CCFs are mostly secondary to arteriosclerotic changes, which explains the increased ratio of elderly patients. Traumatic CCFs are usually of high-flow type and need intervention. The symptoms are various usually correlated to the size and type of venous drainage. The most frequent symptoms on presentation are proptosis, conjunctivitis, and chemosis; however, this picture may be complicated by optic nerve edema, cranial nerve palsies, and intracranial hemorrhage. We report a case with right low-flow dural CCF, which has worsened after angiography and recovered totally soon after endovascular embolization process. Copyright © 2011 by Mutaz B. Habal, MD.