Carotid-cavernous fistula

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  • Fistula between carotid and cavernous sinus
  • Majority arise from trauma
    • Exact mechanism unclear/variable, may arise from small tear in internal carotid or branches due to basilar skull fracture (esp. through sphenoid), shear forces, or abrupt increases in intraluminal pressure when compressed due to neck flexion[1]
  • May also occur spontaneously, due to aneurysms, thrombosis, or weakening in arterial wall

Clinical Features

Possible complications include:

Differential Diagnosis

Bilateral red eyes


  • Conventional angio is gold standard, but can be seen on CT/CTA or MRI/MRA of head/orbits


  • 5-10% close spontaneously[2] remainder must be closed by interventional radiology (e.g. embolization) or surgically


See Also

External Links


  1. UpToDate
  2. Adams and Victor's Principles of Neurology, 10e