1. A 26 year old woman with headache, diplopia, and pulsatile tinnitus Teaching NeuroImages Neurology Resident and Fellow Section © 2013 American Academy of Neurology

2. Vignette A 26-year-old woman developed headache, diplopia, and pulsatile tinnitus in 10 days. Neurological examination revealed limitation of left eye movement, left dilated pupil with optic disc swelling and mild decreased vision, and a bruit over the left superior orbit. Her family history was unremarkable. Laboratory data and cerebral MRI showed normal findings. Cerebral CTA suggested left carotid-cavernous fistula (CCF). Follow-up angiography showed multiple lesions of carotids, vertebral and renal arteries. Yanan Zhang, et al © 2013 American Academy of Neurology

3. Imaging Yanan Zhang, et al AB Figure 1 Figure 2 ABCD 1 2 3 4 5 6 7 8 c © 2013 American Academy of Neurology

4. Carotid-cavernous fistula caused by fibromuscular dysplasia The headache, diplopia, and pulsatile tinnitus of the patient were caused by left CCF, while CCF and multiple arteries lesions were due to fibromuscular dysplasia. FMD is a rare cause for CCF. Yanan Zhang, et al © 2013 American Academy of Neurology