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Presentation type	E-poster
Title	The tragic case of a carotid cavernous fistula

Purpose	We describe the case of 69-year old female presenting on the service of neurosurgery with a carotid cavernous fistula and developing a pseudomonas infection despite complete ptosis which resulted in enucleation.
Methods	Case report of a patient that was diagnosed with an intracavernous tumor during her holidays after experiencing peri-orbital pain on the right side.
Results	Upon urgent return home and presentation at our department, significant exophthalmia as well as peri-palpebral ecchymosis was observed. Spontaneous eye opening was impossible and upon mechanical opening, a complete ophthalmoplegia was noticed. The visual function was lost. Movement and function of the contralateral eye was preserved. Angiography revealed a carotid cavernous fistula with an aneurysm sized 13 x 11 x 19 mm, draining directly in the cavernous sinus. The ophthalmic vein was engorged. Immediate coiling was executed without complications. Afterwards, the patient did not experience any pain but had no light perception nor eye movement, with no subsequent recovery of the visual function. Despite a complete ptosis, the patient developed a pseudomonas infection one week after the coiling. Treated with topical fortified vancomycin and tobramycin, a perforation was avoided. However, due to the lack of visual function, the complete ptosis and its mental impact, the patient opted for an enucleation. This was performed 3 months after the initial presentation.
Conclusion	This case describes a carotid cavernous fistula directly draining into the cavernous sinus, immediately resulting in loss of visual function. This case is unique due to the diameter of the aneurysm resulting in very qualitative imaging, development of a pseudomonas infection despite a complete ptosis and the ultimately resulting enucleation.
Conflict of interest	No

Authors 1

Last name	HELLINCKX
Initials	L
Department	VUB
City	Brussel