Teaching NeuroImages: Ocular bruit in carotid-cavernous sinus fistula

A 57-year-old man who had a traffic accident 1 month previously presented with left ocular pain, double vision, and left eye proptosis with ptosis and conjunctival hemorrhage. Fundus showed dilated veins with no hemorrhages or disc edema. Left ocular motility showed complete external ophthalmoplegia (figure 1). There was prominent ocular bruit in his left eye (audio file on the Neurology® Web site at Neurology.org). MRI and magnetic resonance angiography showed a dilated left superior ophthalmic vein and an extravasation into cavernous sinus (figure 2). With chemosis, ophthalmoplegia, and retro-orbital pain, the auscultation of orbital bruit can make a correct and prompt diagnosis in the patient with carotid-cavernous sinus fistula.1

Source: Neurology - August 11, 2014 Category: Neurology Authors: Choi, J.-Y., Baek, S.-H., Jung, J.-M., Kwon, D.-Y., Park, M. H. Tags: All Imaging, Other cerebrovascular disease/ Stroke, Clinical neurology examination, All Neuro-ophthalmology RESIDENT AND FELLOW SECTION Source Type: research