Traumatic carotid-cavernous fistula presenting as massive epistaxis

Carotid-cavernous sinus fistulae (CCF) are a rare complication with the potential for great morbidity including intracranial hemorrhage, blindness, cranial nerve palsy and stroke. Traumatic CCF are the most common type of CCF. Here we discuss a patient who sustained blunt head trauma and had substantial epistaxis, requiring massive transfusion, intraoperatively due to unrecognized CCF.