A 32-year-old man with delayed onset post-traumatic proptosis and diplopia

Background Proptosis and motility deficits are common findings in the setting of craniofacial trauma, but can indicate the presence of vision and even life-threatening pathology. Objective Our aim was to identify presentations consistent with traumatic carotid cavernous fistula (CCF) and to review the appropriate initial work-up and management. Case Report A 32-year-old man came to our emergency department with proptosis, ocular motility deficits, and decreased vision 1 month after a restrained motor vehicle accident. An orbital bruit was auscultated and four-vessel angiography revealed a CCF. Covered stents and an embolic agent were used to abolish the arteriovenous communication and the patient rapidly returned to his premorbid baseline. Conclusions CCF is a relatively rare but important consequence of craniofacial trauma that must be recognized promptly in order to minimize the likelihood of serious sequelae. It should be suspected in patients with antecedent trauma presenting with exophthalmos, arterialized conjunctival vessels, and orbital bruit.