Communications Between the Carotid Artery and Cavernous Sinus

artery and the cavernous sinus responsible for these symptoms, make this lesion one of the major problems in traumatic vascular surgery. Profound and characteristic disturbances follow its occurrence. Within a few hours after injury there may be edema of the eyelids, face and forehead, the eyeball may become prominent, pulsating and limited in motion through extra-ocular palsies, the conjunctival vessels become congested and suffused, the pupil may be dilated and fixed, and vision is invariably impaired. Occasionally, these signs may be bilateral, with varying degrees of involvement of both eyes. The subjective symptoms are pronounced. Never for an instant is the patient free from the noise in his head which is inescapable and at times intolerable. The noise may be heard on auscultation over the skull, or best over the eyeball itself with the upper lid closed, as a continuous murmur with systolic intensification. It is usually modified or completely controlled by pressure over the carotid on the side of the lesion, but in some cases compression of both carotids is required for complete control. In one instance (Case IV) compression of the carotid on the side opposite the exophthalmos produced a greater effect upon the bruit than compression of the artery on the same side as the presumed communication.