TY - JOUR T1 - Primary intraventricular haemorrhage due to rupture of giant varix of the basal vein of Rosenthal in a patient with long-standing direct CCF: angiographic features and treatment considerations JF - BMJ Case Reports DO - 10.1136/bcr-2017-013396 VL - 2017 SP - bcr-2017-013396 AU - Chinmay P Nagesh AU - Aneesh Mohimen AU - Santhosh K Kannath AU - Jayadevan E Rajan Y1 - 2017/11/16 UR - http://casereports.bmj.com/content/2017/bcr-2017-013396.abstract N2 - Direct carotid cavernous fistulae (CCF) are often detected early and treated promptly resulting in a paucity of literature regarding its long-term evolution. We present a case of high flow post-traumatic direct CCF that was neglected for over 6 years and presented with a rare manifestation of primary intraventricular haemorrhage. Occlusions of the primary venous outlets likely resulted in engorgement of the deep venous system. The segmental anatomy of the shunting basal vein is critical to the clinical presentation and may range from basal ganglia or brainstem oedema/infarctions to uniquely, as in our case, isolated intraventricular haemorrhage secondary to variceal rupture. Treatment in such chronic cases requires a consideration of cerebral hyperperfusion syndrome necessitating deconstructive techniques with subsequent anticoagulation to avoid accelerated thrombosis of the venous varices. ER -