Carotid-cavernous fistula in a child after minimal orbital trauma

We present a case of a direct carotid-cavernous fistula in a seven-year-old child with an unclear history of relatively mild orbital trauma. The child was initially diagnosed with a cranial nerve VI palsy, then admitted with a presumed diagnosis of orbital cellulitis. Further examination, including formal angiography, revealed a direct carotid-cavernous fistula with significant cortical venous drainage requiring prompt intervention. Treatment of the fistula by coil occlusion was successful. This case illustrates the importance of recognizing and understanding the pathophysiology and treatment of this rare but potentially fatal entity.