Serial Color Doppler in Paradoxical Worsening of a Dural-Cavernous Fistula

When the syndrome of paradoxical worsening of dural-cavernous fistulas (DCF} was first described, MRI and anteriography were instrumental in making this diagnosis (1 ). The advent of orbital color Doppler imaging (CDI), however, presents a new non-invasive technique to follow these patients. Although previous reports have shown the color Doppler appearance of arteriovenous fistulas {AVF) of the cavernous sinus (2,3), this is the first demonstration of serial CDI examinations in a patient developing paradoxical worsening of a DCF with subsequent clinical improvement.