Delayed carotid-cavernous fistula and multiple cranial neuropathy following basal skull fracture

A case of basilar skull fracture associated with palsies of the 3rd through 10th cranial nerves on the ipsilateral side is presented. Three months after the initial injury, despite return of significant ocular movement, proptosis and conjunctival congestion heralded the onset of an ipsilateral carotid-cavernous fistula. Angiography revealed the presence of a carotid-cavernous fistula; however, the ipsilateral carotid artery was occluded in the neck. A single pathophysiological mechanism is proposed to account for this unique series of events.