A 40-year-old male with a history of accident 2 days back presented to the ER with complaints of redness of eye, diplopia, decreased vision and facial pain in the distribution of ophthalmic division of trigeminal nerve. On examination, Bruit was heard over the eyes Proptosis Ocular pulsations Exposure keratopathy Pulsating exophthalmos MRI brain The aery involved in the above condition passes from which of the following structures: -

This is a case of carotid cavernous fistula. MRI brain shows enlarged superior ophthalmic vein - characteristic of Caroticocavernous fistula. Caroticocavernous fistulas (CCF) represent abnormal communication between the carotid circulation and the cavernous sinus. Direct CCFs are often secondary to trauma, and as such the demographics reflect the distribution of head trauma, most commonly seen in the young male patients. The presentation is acute and symptoms develop rapidly. Clinical features: - Pulsatile exophthalmos Chemosis and subconjunctival hemorrhage Proptosis Progressive visual loss Pulsatile tinnitus Raised intracranial pressure Subarachnoid hemorrhage, intracerebral hemorrhage, otorrhagia, epistaxis Cranial nerve palsies The internal carotid aery is a content of foramen lacerum.