Caroticocavernous fistula (direct)

Case contributed by Frank Gaillard

Presentation

This patient was involved in an MVA a month previously, and subsequently developed chemosis and a objective tinitus.

Angiogram confirmed the presence of a direct caroticocavernous fistula

Note the brisk shunting, dilated veins (especially the superior ophthalmic vein) and reflux into cortical veins. (a poor prognostic factor).

Also note the contralateral supply of the ACA and to a lesser degree right MCA.

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