Introduction: Intracranial arterial injury is typically associated with high-energy trauma. Early diagnosis and treatment are essential for improving patients' functional prognosis.
\nCase Presentation: A 76-year-old woman complained of pulsatile tinnitus on the 15th day after her traffic accident, in which she got injured only a bruise to her face, while severe injuries to her torso. On the 17th day, ptosis, conjunctival congestion, and an ocular motility disorder developed in her right eye. Magnetic resonance angiography showed a direct high-flow shunt from the internal carotid artery to the cavernous sinus. On the 20th day, the same symptoms developed in her left eye. On the 23rd day, coil embolization to the fistula reduced symptoms in the left eye, but not the right eye.
\nDiscussion: This complication rarely occurs in patients with head trauma. Our case indicates that this can occur even in patients without obvious head or facial trauma, and even in the subacute phase of trauma care.
","language":"eng","license":{"name":"Creative Commons Attribution 4.0","short_name":"CC BY 4.0","text":"Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.\r\n\r\nNo additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.","url":"https://creativecommons.org/licenses/by/4.0"},"keywords":[{"word":"Carotid-Cavernous Sinus Fistula"},{"word":"delayed diagnosis"},{"word":"Multiple Trauma"},{"word":"Trauma and Stressor Related Disorders"}],"section":"Case Reports","is_remote":true,"remote_url":"https://escholarship.org/uc/item/5m21n0nw","frozenauthors":[{"first_name":"Yoshihiro","middle_name":"","last_name":"Miyake","name_suffix":"","institution":"University of Miyazaki, Department of Emergency and Critical Care Medicine, Miyazaki, Japan; Miyakonojo Medical Association Hospital, Department of Emergency and Critical Care Medicine, Miyazaki, Japan","department":""},{"first_name":"Tomohiro","middle_name":"","last_name":"Abe","name_suffix":"","institution":"University of Miyazaki, Department of Emergency and Critical Care Medicine, Miyazaki, Japan; Cardiovascular Biology Research Program, Oklahoma Medical Research Foundation, Oklahoma City, Oklahoma","department":""},{"first_name":"Keisuke","middle_name":"","last_name":"Kubo","name_suffix":"","institution":"University of Miyazaki, Department of Emergency and Critical Care Medicine, Miyazaki, Japan; Miyakonojo Medical Association Hospital, Department of Emergency and Critical Care Medicine, Miyazaki, Japan","department":""},{"first_name":"Hideki","middle_name":"","last_name":"Nagoshi","name_suffix":"","institution":"University of Miyazaki, Department of Emergency and Critical Care Medicine, Miyazaki, Japan; Miyakonojo Medical Association Hospital, Department of Emergency and Critical Care Medicine, Miyazaki, Japan","department":""},{"first_name":"Hidenobu","middle_name":"","last_name":"Ochiai","name_suffix":"","institution":"University of Miyazaki, Department of Emergency and Critical Care Medicine, Miyazaki, Japan","department":""}],"date_submitted":"2025-06-24T18:20:40.537000Z","date_accepted":"2025-10-23T18:53:11.252000Z","date_published":"2026-03-29T22:02:00Z","render_galley":null,"galleys":[{"label":"PDF","type":"pdf","path":"https://journalpub.escholarship.org/uciem_cpcem/article/48556/galley/49308/download/"}]}