Traumatic carotid-cavernous fistula presenting as massive epistaxis

Area of Science:

• Neurosurgery
• Vascular Surgery
• Trauma Surgery

Background:

• Carotid-cavernous sinus fistulae (CCF) are rare but serious vascular complications.
• Traumatic CCF represent the most frequent etiology of this condition.
• CCF can lead to severe neurological deficits and significant morbidity.

Observation:

• A patient presented with blunt head trauma and severe epistaxis.
• The epistaxis was substantial, requiring massive intraoperative blood transfusion.
• The underlying cause, a carotid-cavernous sinus fistula, was initially unrecognized.

Findings:

• Unrecognized carotid-cavernous sinus fistula as a cause of massive epistaxis in blunt head trauma.
• The critical need for prompt diagnosis and management of CCF in trauma settings.
• The potential for CCF to present with severe, life-threatening hemorrhage.

Implications:

• Highlights the importance of considering CCF in patients with severe epistaxis post-trauma.
• Underscores the potential for significant morbidity if CCF is not promptly identified and treated.
• Emphasizes the need for heightened vigilance in diagnosing vascular injuries following head trauma.