Communicating carotid-cavernous sinus fistula following minor head trauma

A 45-year-old Caucasian male presented to the emergency department of a tertiary care hospital with the chief complaint of blurred vision and facial numbness. The patient had experienced a minor head injury 1 month ago with loss of consciousness. After a 2-week symptom-free period, he developed scalp and facial numbness, along with headache and vision problems. His vital signs were within normal limits, but on examination the patient was noted to have orbital and carotid bruits with several concerning neurological findings. CT and MRI confirmed the suspicion of carotid-cavernous sinus fistula, which was managed by cerebral angiography with coil embolization of this fistula. The patient was symptom free at the 8-month follow-up.Carotid-cavernous sinus fistula is a rare condition that is usually caused by blunt or penetrating trauma to the head, but can develop spontaneously in about one fourth of patients with CCF. The connection between the carotid artery and cavernous sinus leads to increased pressure in the cavernous sinus and compression of its contents, and thereby produces the clinical symptoms and signs seen. Diagnosis depends on clinical examination and neuroimaging techniques. The aim of management is to reduce the pressure within the cavernous sinus, which results in gradual resolution of symptoms.A carotid-cavernous sinus fistula (CCF) is a rare condition well known in the neurosurgical field, but not well published in emergency medicine literature. Whether post-traumatic or spontaneous in nature, the symptoms related to CCFs are insidious and potentially severe. From chronic headaches and diplopia, to intracranial hemorrhage [1] and permanent vision loss [2,3], the ability to identify and manage this disease is essential. The clinical presentations of CCFs can be varied as well, mimicking diseases like multiple sclerosis, brain tumors, or stroke, making it imperative that emergency physicians in the right setting include this disease in their differential