An unresponsive 42-year-old patient with seizure.

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Carotid cavernous fistula: an easily missed

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Presentation transcript:

An unresponsive 42-year-old patient with seizure. An unresponsive 42-year-old patient with seizure. (A) CT of the head revealed a left posterior temporal intraparenchymal hemorrhage. (B) Lateral view of left external carotid artery injection showed an aggressive dural arteriovenous fistula (DAVF) with an isolated pathologic transverse–sigmoid sinus (double arrows) and cortical venous reflux (single arrow). Arterial feeders can be seen from branches of the middle meningeal artery (MMA), occipital artery and posterior auricular artery. (C) Unsubtracted lateral view showing the Onyx casting from a single infusion via the left MMA resulting in a complete angiographic cure (D). At 6 months (E), no residual DAVF is seen, demonstrating the durability of the Onyx cast. (Used with permission from Barrow Neurological Institute). Yin C Hu et al. J NeuroIntervent Surg 2011;3:5-13 Copyright © Society of NeuroInterventional Surgery. All rights reserved.