Clinical features
The clinical features of a carotid cavernous fistula are usually unilateral but bilateral signs may develop as a result of communication with the contralateral venous sinus.
Characteristically, there is:
- sudden onset of pain
- prominent facial veins
- III, IV and VI nerve palsies
- papilloedema, retinal haemorrhage, optic atrophy and consequent visual impairment
- exophthalmos - may be pulsatile
- cranial bruit heard best over the eyeball
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