Direct Carotid-Cavernous sinus Fistula Following Closed Head Injury

A case of direct carotid-cavernous sinus fistula (CCF) after closed head injury is presented. A22-year-old male presented to the emergency department of Shohada Tajrish Hospital with thechief complaint of blurred vision and pulsatile retro-orbital headache. The patient had closed headinjury due to car accident 2 month ago with lower limb fracture. After a 2-week symptom-freeperiod, he developed scalp and right facial tingling, along with pulsatile retro-orbital headacheand vision problems. His vital signs were within normal limits, but on primary evaluationthe patient orbital and carotid bruits could be recognized. Computed tomography (CT) scanand magnetic resonance imaging (MRI) suggested the carotid-cavernous sinus fistula, whichwas confirmed by brain angiographic imaging findings. Carotid-cavernous sinus fistula is anuncommon condition that is usually caused by head trauma but can advance spontaneously inabout one fourth of patients with CCF. The connection between the carotid artery and cavernoussinus leads to increased pressure in the cavernous sinus and compression of its contents, andfinally advances the clinical symptoms and signs seen. Diagnosis is based on clinical evaluationand neuroimaging techniques. The target of management is to decrease the pressure within thecavernous sinus, which results in gradual recovery of symptoms