Brainstem edema: an unusual complication of carotid cavernous fistula.

The complications of carotid cavernous fistula include (1) intracerebral hematoma, subarachnoid hemorrhage, intraorbital hemorrhage, epistaxis, and otorrhagia [1-4]; (2) blurred vision or loss of vision caused by secondary glaucoma, intraorbital hemorrhage, or other causes [1, 5] ; (3) cerebral ischemia due to steal of blood by the fistula [1 ]; (4) progressive proptosis [1, 5] ; (5) increased intracranial pressure [1 ]; and (6) limitation of ocular movements [1 , 5]. Recently, we encountered two cases of carotid cavernous fistula with the unusual complication of brainstem edema. Both patients had direct-type carotid cavernous fistulas , which occurred after head injury.