Traumatic Dissecting Aneurysm of Middle Cerebral Artery and Carotid-Cavernous Fistula with Massive Intracerebral Hemorrhage

C AROTID-CAVERNOUS fistula poses no problem for diagnosis because of the impressive pulsating exophthalmos. In spite of a common belief that the lesion is usually easily and successfully treated by ligation of one or another artery leading to the fistula, the rate of cure is actually less than 50 %? Reasons for such poor results are not clear, since the complications of treatment are not frequently reported, but cerebral ischemia and hemorrhage appear to predominate. The former is easily understood, but the pathogenesis of cerebral hemorrhage is not clear? Postmortem analysis of the following case showed an interesting series of lesions which could have accounted for the terminal massive intracerebral hemorrhage.