Kaplan et al. International Journal of Emergency Medicine 2012, 5:10 http://www.intjem.com/content/5/1/10 C A S E R E P O R T Open Access Communicating carotid-cavernous sinus fistula following minor head trauma Joshua B Kaplan, Aakash N Bodhit* and Michael L Falgiani Abstract Introduction: A case of communicating carotid-cavernous sinus fistula (CCF) after minor closed head injury is presented. Case presentation: A 45-year-old Caucasian male presented to the emergency department of a tertiary care hospital with the chief complaint of blurred vision and facial numbness. The patient had experienced a minor head injury 1 month ago with loss of consciousness. After a 2-week symptom-free period, he developed scalp and facial numbness, along with headache and vision problems. His vital signs were within normal limits, but on examination the patient was noted to have orbital and carotid bruits with several concerning neurological findings. CT and MRI confirmed the suspicion of carotid-cavernous sinus fistula, which was managed by cerebral angiography with coil embolization of this fistula. The patient was symptom free at the 8-month follow-up. Discussion: Carotid-cavernous sinus fistula is a rare condition that is usually caused by blunt or penetrating trauma to the head, but can develop spontaneously in about one fourth of patients with CCF. The connection between the carotid artery and cavernous sinus leads to increased pressure in the cavernous sinus and compression of its contents, and thereby produces the clinical symptoms and signs seen. Diagnosis depends on clinical examination and neuroimaging techniques. The aim of management is to reduce the pressure within the cavernous sinus, which results in gradual resolution of symptoms. Introduction A carotid-cavernous sinus fistula (CCF) is a rare condi- tion well known in the neurosurgical field, but not well published in emergency medicine literature. Whether post-traumatic or spontaneous in nature, the symptoms related to CCFs are insidious and potentially severe. From chronic headaches and diplopia, to intracranial hemorrhage [1] and permanent vision loss [2,3], the ability to identify and manage this disease is essential. The clinical presentations of CCFs can be varied as well, mimicking diseases like multiple sclerosis, brain tumors, or stroke, making it imperative that emergency physi- cians in the right setting include this disease in their dif- ferential diagnosis. We report a case of a patient with a communicating CCF that presented to our Emergency Department (ED) 1 month after suffering a closed head injury at a party. * Correspondence: aakashnb@ufl.edu Department of Emergency Medicine, University of Florida College of Medicine, 1329 SW 16th Street, PO Box 100186, Gainesville, FL 32610, USA Case presentation A 45-year-old Caucasian male presented to the emer- gency department with the chief complaint of “blurred vision and facial numbness.” The patient recalled that a month ago he had been drinking with friends when he was either punched or struck in the back of the head by an unknown object. He lost consciousness but did not seek medical attention at the time, stating that he “felt fine.” He remained symptom-free for the next 2 weeks, until he developed left scalp and left facial numbness, and noted that he could not clench his jaw tightly on that side. Over the next week his symptoms had increased to include: right-sided scalp and forehead numbness, right- sided droopy eyelid, light sensitivity, double vision, diffi- culty walking in a straight line, bilateral pulsating tinni- tus, and a throbbing occipital to retro-orbital headache. With increasing difficulty performing his job as an elec- trician, he presented to the ED seeking medical atten- tion for the first time. © 2012 Kaplan et al; licensee Springer. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.