Carotid-cavernous Fistula in a Patient with Minimal Head and Facial Trauma: A Case Report

Introduction: Intracranial arterial injury is typically associated with high-energy trauma. Early diagnosis and treatment are essential for improving the patient’s functional prognosis. Case Report: A 76-year-old woman complained of pulsatile tinnitus 15 days post motor vehicle collision. On presentation she was found to have sustained polytrauma, mostly to her abdominal and thoracic regions, as well as a facial contusion. She then developed ptosis, conjunctival congestion, and an ocular motility disorder in all directions in her right eye. Magnetic resonance angiography showed a direct high-flow shunt from the internal carotid artery to the cavernous sinus. Similar symptoms then developed on her left side. She underwent successful embolization to the left-sided fistula. Conclusion: Fistulization of the carotid with the cavernous sinus is a rare complication of head or facial trauma. Our case indicates that this can occur even in patients with seemingly minor head or facial trauma.