Posttraumatic carotid-cavernous fistula associated with evolving contralateral internal carotid artery pseudoaneurysm

Head trauma can result in vascular injuries at the base of skull. We present a unique case of carotid-cavernous fistula (CCF) on one side with evolving contralateral internal carotid artery (ICA) aneurysm resulting from a single trauma. There were different pathomechanisms involved in the development of these lesions. Both these lesions were successfully managed with endovascular coiling. The case cautions us about a potential threat of another delayed lesion forming on contralateral side once an ipsilateral posttraumatic vascular lesion has been treated. The case also highlights the importance of carefully looking for the ICA on both sides during digital subtraction angiography in trauma patients.