Indirect Carotid Cavernous Fistula

A 72-year-old female referred to Bascom Palmer Emergency room with 4 months of progressive painless diplopia and eye redness after dental procedure. Exam revealed VA 20/25 OU with bilateral abducens palsy, and arterialization of the conjunctival vessels. Review of outside imaging revealed concern for possible carotid-cavernous fistula. Patient underwent angiography and a partially thrombosed indirect carotid-cavernous fistula fed from the meningohypophyseal trunk (MHT) without cortical drainage. Dual-anti platelet therapy was initiated, and repeat angiography was performed at 3 weeks. A persistent filling defect was seen and balloon occlusion test (BTO) was favorable with good neck collaterals. Coiling and sacrifice of the right internal carotid artery (ICA) was performed with resolution of the filling defect. 

Presentation Date: 09/05/2019

Issue Date: 08/01/2020