Delayed intracerebral hemorrhage from a traumatic carotid-cavernous fistula associated with an enucleated orbit

Spontaneous intracerebral hemorrhage (ICH) from a traumatic carotid-cavernous fistula (CCF) is a rare occurrence with few cases reported in the literature. Patients classically present shortly after the inciting trauma with symptoms of ocular venous hypertension. We report a case of an ICH due to delayed rupture of a venous aneurysm from a CCF in a patient with decades-old history of enucleation of the left globe secondary to trauma with no sentinel symptoms. Our patient represents a unique presentation of a rare pathology. This case highlights the need for ongoing surveillance in patients with a history of severe craniofacial trauma, as ICH from ruptured CCF(s) demands emergent treatment due to the potential for rapid neurological deterioration.