TY - JOUR T1 - Bilateral spontaneous carotid-cavernous fistulae JF - Practical Neurology JO - Pract Neurol SP - 261 LP - 263 DO - 10.1136/practneurol-2020-002868 VL - 21 IS - 3 AU - Tara Tran AU - Julian Maingard AU - Shalini Amukotuwa AU - Udaya Seneviratne Y1 - 2021/06/01 UR - http://pn.bmj.com/content/21/3/261.abstract N2 - A man in his late fifties had right-sided retro-orbital pain and diplopia for 1 month. There was no preceding head trauma. On examination, he had a right abducens palsy with subtle bilateral chemosis and proptosis, but no ocular bruit. The visual acuities were 6/9 on the right and 6/6 on the left whereas pupils, funduscopy, visual fields by confrontation, colour vision and intraocular pressures (right 15 mm Hg, left 20 mm Hg) were normal bilaterally. MR scan of brain (T2-weighted images) showed bilaterally abnormal flow voids in the cavernous sinuses, with enlargement of the cavernous sinuses, right superior ophthalmic vein and left spheno-parietal sinus (figure 1A,B). Follow-up MR imaging with time-of-flight MR cerebral angiography showed abnormal flow signals in these venous structures, indicating a carotid-cavernous fistula (figure 1D). Digital cerebral angiogram confirmed bilateral indirect carotid-cavernous fistulae (barrow type D, see below) with retrograde cortical venous reflux (figure 2), which were successfully treated with endovascular embolisation.Figure 1 MR scan of brain showing features of a bilateral indirect carotid-cavernous fistula. (A) Coronal T2-weighted image showing enlargement of the cavernous sinuses (arrowheads). Nodular and curvilinear areas of very low signal within the cavernous sinuses (white arrows) represent fistulous channels. The fast blood flow in these … ER -