Carotid-Cavernous Fistula: Hemodynamic Dysfunction After Shingles?

We report a rare case of carotid-cavernous fistula (CCF) development post-shingles. CCF is a vascular abnormality that usually present with ophthalmic symptoms. It usually occur after a form of cavernous sinus hemodynamic dysfunction. Although most cases are thought to be related to history of hypertension, atherosclerosis, or trauma, in our case developing CCF is likely herpes-related etiology. Most CCFs are associated with a triad of symptoms: proptosis, bruit, and chemosis of the conjunctiva. Our patient was presented with diplopia, red eye and headaches. CCFs often clinically present with a significant amount of ophthalmic manifestations, prompting visits with ophthalmologists or optometrists. The most prominent treatment used for CC fistulas is endovascular embolization, which usually results in significant improvement in symptoms.