1. Unusual Acute Complication Of Carotid Cavernous Fistula Fong Y Tsai,MD FACR UCI Medical Center, Orange,Ca. USA

2. Clinical Symptoms Upon Of Size,Site,Duration and Venous drainages: Slowly Worsen as increasing Arterial Shunting and Venous Pressure

3. Acute Complication Rarely reported,usally during therapeutic procedure Increased Intracranial pressure from shunting of petrosal sinus into sigmoid sinus Subarachnoid hemorrhage from varix of cavernous sinus

4. Case Report 28/M acute headache and vomiting,head trauma 5 years ago

8. Cerebral Venous System Cerebral Venous system is so varied Venous drainages of CC fistula may be impaired and induced venous hypertension and increased intracranial pressure

9. Case report 48/M suffered head trauma from a fall with multiple facial and C2 fractures and through left carotid canal. He had epistaxis from left orbital and nasal injury.

11. Embolization For Right Epistaxis

13. Jugular Vein Stenosis

14. Follow-Up CT 3 Days Later

17. Case Report 58/M suffered head trauma from MVA with multiple skull fractures with Pneumocephaly, SAH and small SDH

19. Follow-Up CT 5 days Later and Coma

23. Case Report 44/F recovered from severe MVA,she had increased ecchymosis,exophathalmos and severe eye pain. Acute hemorrhage of left eye

24. CT Of Orbit

28. Case Report 36/F presented with swelling, exophathalmos and ecchymosis of left eye. She experienced significant pulsatile tinnitus for 2 years

31. Increasing Headache

35. Case Report 60/F presented with Protosis and edema of right eye with double vision No bruit was noted

37. Stenosis of Distal Jugular Vein

38. New Right Ear Bruit

40. Spontaneous Resolution

41. Venous Drainages AV Shuntings are important for symptoms of CC fistulas Venous drainages may be important for management of CC fistulas Impaired venous drainages may induce venous hypertension and acute complications

42. Venous hypertension CC Fistula may induce venous hypertension from AV shunting and outlet obstruction Venous hypertension leads to venous congestion with hemorrhage and dural sinus fistula and venous occlusion.

43. Thanks For Attention Thank you for the opportunity to present my experience