Supraclinoid carotid artery fistula mimicking a carotid-cavernous fistula

Abstract

Pulsatile exophthalmos syndrome (PES) is characterized by conjunctival injection, orbital bruit, chemosis, exophthalmos, and palpebral edema. It is usually associated with glaucoma, decreased visual acuity, and extrinsic ophthalmoplegia, and mostly secondary to carotid-cavernous fistulas (CCFs), an abnormal communication between the intracavernous segment of the carotid artery and the venous channels in cavernous sinus. We present a case of an abnormal communication between the supraclinoid segment of the carotid artery and the coronary sinus that drains into the contralateral ophthalmic vein simulating a CCF. It was succesfully treated by coil embolization using a percutaneous approach. Other reported rare causes of PES and treatment modalities by embolization are reviewed.