Unilateral blindness as the only finding in a patient with high flow carotid-cavernous fistula

ABSTRACT

The authors reported a patient with unilateral blindness of the left eye after trauma. Apart from paralysis of the 4th cranial nerve and mild optic nerve edema, there was no structural problem during the ophthalmologic examination. Brain CT scan, CT angiography and MRI demonstrated aneurysm in the left pericavernous region. The patient underwent angiography for coiling of the aneurysm, which detected large carotid cavernous fistula [CCF] mainly draining into the petrous sinus. Therapeutic embolization was performed with balloon and the CCF vanished completely. The most important points of this case are the blindness without exophthalmia as the only presentation of CCF which has not been reported as the only symptom and failure of CT-angiography and MRI evaluation for the diagnosis of CCF