After the spontaneous relief of initial symptoms by traumatic carotid-cavernous fistula (CCF), paradoxical worsening of patient's condition can be followed. We present a case of a 60-yr-old man whose audible bruit from a traumatic CCF had completely disappeared. A few days later, however, the patient had spontaneous intracerebral hematoma with cortical venous drainage. Complete obliteration of the fistula was achieved after embolization. When initial audible bruit in traumatic CCF disappears suddenly, cerebral angiography should be performed to differentiate venous hypertension by the hemodynamic changes of the cavernous sinus channels from spontaneous resolution of CCF.
Brain/pathology ; Carotid Arteries/pathology ; Carotid-Cavernous Sinus Fistula/*complications/*pathology/therapy ; Cerebral Angiography/methods ; Cerebral Hemorrhage, Traumatic/*etiology/therapy ; Humans ; Male ; Middle Aged ; Research Support, Non-U.S. Gov't ; Tomography, X-Ray Computed/methods