The indirect carotido-cavernous fistula is an abnormal communication between multiple arterioles coming from dural or meningeal branches of the external carotid artery and/or of the internal carotid artery and the cavernous sinus. Its definitive diagnosis relies on carotid angiography showing the fistula. This imaging procedure is not available in our medical context, hence the importance of clinical indirect signs (exophthalmos with Medusa-head dilatation of the conjunctival vessels) and of CT angiography of the brain (dilation of the superior ophthalmic vein) to suggest the appropriate diagnosis and eliminate differential diagnosis (orbital tumor, thyroid exophthalmos, pseudo inflammatory tumor, etc.). We report the case of a 58-year old patient who presented with exophthalmos and progressive vision loss in the left eye which had evolved over the previous year. The patient had a history of left orbital trauma caused by road accident three years before. Left exophthalmos was axile, reducible, non-pulsatile, with no audible breath, painless, without limitation of the eye movements and satellite adenopathy (A). The left eye conjunctival and retinal vessels were dilated (A, B). Right eye examination and thyroid function were normal. CT angiography of the brain showed enlarged left superior ophthalmic vein (C). The insufficiency of technical equipment, endovascular status suggesting embolization forced us to make symptom management: artificial tear and hypotensive eye drops.
The Pan African Medical Journal 2016;24