Traumatic Carotid-cavernous Fistula with Contralateral Proptosis: Case Report

ABSTRACT

Traumatic carotid-cavernous fistula frequently results in proptosis on the side of the fistula by retrograde drainage from the cavernous sinus to the superior ophthalmic vein. The involvement of the opposite orbit is due to the presence of connections between the cavernous sinuses on both sides, but exclusive contralateral orbit involvement is rare. We report a case in which the CCF with a contralateral proptosis developed in a 63 year-old man after a motor vehicle accident. MR angiography depicted the markedly dilated left cavernous sinus and left superior ophthalmic vein, sparing the right side. However, angiography showed a direct fistula between the right internal carotid artery and cavernous sinus with exclusive contralateral venous drainage via the intercavernous sinus. A detachable balloon was used to occlude the fistula, and the contralateral orbital symptom regressed.