• Maria E Gregory, Antonella Berry-Brincat, Yajati K Ghosh, Reshma N Syed, Palitha L Diaz, and Timothy L Jordan.
• Department of Ophthalmology, University Hospital of Staffordshire, 17 Steel Street, Hartshill, Stoke on Trent, N. Staffordshire ST4 7NS, United Kingdom. rgregory@tesco.net
• Am. J. Ophthalmol. 2005 Sep 1; 140 (3): 548-50.

PurposeTo describe a case of an occipital arteriovenous malformation (AVM) presenting with unilateral signs mimicking a carotid-cavernous sinus fistula (CCF).DesignInterventional case report.MethodsA 67-year-old normotensive male presented with loss of vision, pain, and proptosis of the right eye. Best-corrected visual acuity was right eye 6/36 and left eye 6/5. Examination of the right eye revealed orbital congestion with arteriolization of the episcleral vessels and an intra-ocular pressure of 44 mm Hg which was refractory to medical treatment.ResultsComputed tomography (CT) angiogram and cerebral angiography found an occipital AVM draining into the right sphenoparietal sinus and thereafter the right ophthalmic vein, bypassing the cavernous sinus. Embolization followed by excision of the AVM resulted in recovery of vision, reversal of proptosis, and normalization of intraocular pressure.ConclusionsRapid diagnosis and immediate intervention resulted in a rewarding visual recovery despite a persisting left homonymous hemianopia.

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