Left-Sided Carotico-Cavernous Fistula Manifesting as Severe Proptosis: A Case Report

Carotico-cavernous fistula (CCF) is an abnormal arteriovenous communication between the carotid arterial system and the cavernous sinus, resulting in orbital venous congestion and potential visual morbidity. We report a case of a patient presenting with a 20 days history of progressive left-sided ocular pain, redness, swelling, and proptosis. Ophthalmic evaluation revealed reduced visual acuity, conjunctival congestion, chemosis, and elevated intraocular pressure. Exophthalmometry demonstrated proptosis of 25 mm in the left eye compared to 14 mm in the right eye. Fundus examination was unremarkable. Magnetic resonance imaging revealed a suspicious communication between the cavernous segment of the left internal carotid artery and the cavernous sinus, confirming the diagnosis of CCF. The patient underwent successful endovascular management with embolization using coils via transarterial/transvenous approach, resulting in obliteration of the fistulous communication. Early diagnosis and prompt intervention are essential to prevent irreversible visual complications. DOI: https://doi.org/10.52783/jchr.v16.i4.15766