A CASE REPORT OF POST TRAUMATIC CAROTID CAVERNOUS FISTULA WITH ABDUCENT NERVE PALSY

Abstract

A 55 year old male, Rajendran, came to our hospital with history of binocular diplopia and defective vision in RE for the past 1 month. History of forward protrusion of eyeball(RE) for the past 1 month. History of trauma 2 months back(road traffic accident ,hit by a two wheeler while walking) following which patient was admitted at our hospital and   diagnosed as a case of RE traumatic optic neuropathy and given a course of IV methyl prednisolone 500 mg iv BD for 3 days followed by 11 days treatment of tab Prednisolone 50 mg OD. On ocular examination RE epibulbar injection with cork screwing of blood vessels and abduction restriction was noted. In BE there was an axial proptosis (RE more than LE).CT Orbit plain and contrast showed both sided carotid cavernous fistula (RE more than LE) with right petrous apex fracture with fracture right zygomatic arch. Bruit was heard on auscultation with the bell of stethoscope over the upper lid which diminished on carotid artery compression (RE more than LE). Patient was referred to neurosurgery department for further management. Under GA, 6F sheath placed, balloon introduced and fistula closed through right common femoral artery approach. The patient came to follow up after 10 days to ophthal OPD. The proptosis has subsided. Patient was symptomatically better. Bruit was not heard on  auscultation. Abduction restriction was present.