Affiliations: Department of Radiology, The Johns Hopkins Hospital, Baltimore, MD, USA | Division of Interventional Neuroradiology, The Johns Hopkins Hospital, Baltimore, MD, USA | Interventional Neuroradiology Section, Children’s National Medical Center, Washington, DC, USA
Abstract: A 3-year-old girl with trisomy 21 presented with progressive proptosis, scleral injection, and pulsatility of her right eye 1 month following minimal blunt head trauma. Computed tomography suggested a carotid cavernous fistula (CCF), which was confirmed by digital subtraction angiography and further classified as an indirect, Barrow type D CCF. Treatment was proposed because of vision-threatening elevated intraocular pressures. Transvenous coil embolization of the CCF was successfully performed. The patient was discharged to home 2 days after the procedure with immediate clinical improvement of her proptosis and normalization of her intraocular pressures on follow-up ophthalmologic visit 2 wk later.