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This female patient presented to the emergency department with proptosis, eyelid hyperaemia and progressive blurring of the right side of her vision over the previous month. Physical examination found no further abnormalities and no additional symptoms were reported. She had a history of non-penetrating head trauma 40 days prior. There was no family history of vascular disorders. Orbital CT scan showed a dilated superior ophthalmic vein and orbital MRI revealed increased signal intensity and vascularity in the right orbital apex. MRA of the carotid circulation demonstrated a fistula between the internal carotid artery and the cavernous sinus. The patient was treated conservatively and did not receive any intervention for the arteriovenous fistula. Her vision and symptoms gradually improved over a follow-up interval of 6 months.
Patient at presentation
Orbital CT showing dilated superior opthalmic vein
Consent and permission for use of patient photographs was confirmed by and remains sole responsibility of the submitting author:
Dr Payman Moharamzadeh
Assistant professor of Emergency and Accident
Imam Reza Hospital Tbariz University of Medical sciences