Post-traumatic carotid–cavernous fistula

A 46-year-old man attended the emergency department with a 24-hour history of sudden onset and progressive proptosis of the left eye. Over the previous days, he had experienced severe nausea and vomiting, causing multiple Valsalva manoeuvres. He had been discharged from hospital 12 days before after a severe head injury with skull base fractures affecting the central part of the sphenoid bone. On examination, he had a left exophthalmos, periorbital oedema with significant chemosis, with loss of all eye movements on the left (frozen eye), decreased visual acuity and elevated intraocular …