DOI: https://doi.org/10.36347/sasjs.2025.v11i10.017

Pages: 1028-1031

Carotid-cavernous fistula (CCF) is an abnormal connection between the internal carotid artery and the cavernous sinus, often resulting from trauma. It typically presents with ocular symptoms and cranial nerve deficits. However, atypical presentations, such as isolated cranial nerve palsies without overt ocular signs, can complicate diagnosis. A 30-year-old patient was involved in a motor vehicle accident, resulting in blunt trauma to the temporal bone. Clinical examination revealed hemotympanum and sixth cranial nerve palsy (abducent nerve palsy) without exophthalmos or other ocular signs. A non-contrast CT scan of the head showed no fractures, and further MRI imaging revealed a high-flow carotid-cavernous fistula, confirmed by the presence of flow voids in the cavernous sinus region. This case highlights the importance of considering carotid-cavernous fistula in patients with temporal bone trauma and cranial nerve palsies, even in the absence of classic ocular symptoms. Early diagnosis via MRI can guide appropriate management, which may include endovascular intervention to prevent further complications.