Carotid cavernous fistula.

Although carotid cavernous fistulas from head trauma are rare, definitive diagnosis is usually not difficult. The presence of a temporal, orbital, or supraorbital bruit on auscultation enables the clinician to exclude most other pathologic conditions that affect the orbital structure. Recent advances in neuroangiography seem to make balloon catheterization the treatment of choice, precluding the necessity to embolize the fistula or ligate the internal carotid artery outside the cavernous sinus. Early recognition and treatment usually results in total resolution, but return of full visual acuity and ocular mobility was delayed approximately four months in our patient.