Brainstem venous congestion due to a direct carotid-cavernous fistula: Case report

A 50-year-old male patient who, after 3 months of cranial brain trauma, presented proptosis, chemosis and exophthalmos in the left eye. Subsequently, dysmetria develops in the left extremities and right hemiparesis. The diagnosis of carotid-cavernous fistula (FCC) associated with hyperintensity of signal in FLAIR and diffuse contrast uptake at the level of the pseudo tumoral protuberance and cerebellar peduncle was established. This finding was compatible with venous congestion. His symptoms were fluctuating, he started with orbital symptoms and then from the posterior fossa with improvement of the orbital symptoms. FCC microcoil embolization produced resolution of ocular symptoms followed by improvement of brainstem symptoms. Magnetic resonance findings significantly reversed one year of follow-up. We describe a case of direct FCC with venous congestion in the brainstem and fluctuating symptoms with a considerable clinical and imaging improvement after treatment.