Thursday, May 17, 2012


A 30 year old man who had a recent motor vehicle accident where he sustained a basilar skull fracture, a humerus fracture, and multiple rib fractures, now presents with weird symptoms of "pulsating" over his right eye. In fact, you auscultate a bruit over his eye. He also has blurred and double vision, headache, and ocular pain. Examination shows some proptosis and chemosis of the eye. Extraocular movements are limited and there is some facial sensory loss.

Challenge: What's the diagnosis?

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sid said...

Carotico-cavernous fistula due to the rupture of the internal carotid artery with involvement of III IV VI nerves and bilateral conjunctival edema because the cavernous sinus communicates to the other side.

Craig Chen said...

yes! always seemed to me as a scary diagnosis

This is a carotid-cavernous fistula, an acquired vascular malformation between the carotid arteries and the cavernous sinus.

Source: UpToDate.