case_images: PMC9981213_01
case_images: Needlefish.. Photo credit: Mark Radcliffe
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case_images: FIG1
case_images: Residual teeth and foreign materials from the fish remained in the wound (Figure 1).
case_images: Right periorbital edema, discharge and ecchymosis.
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case_images: FIG2
case_images: She presented to a local emergency department with significant periorbital pain and swelling (Figure 2).
case_images: MRI of CSVT: The post-GAD T1 shows a possible filling defect within the right cavernous sinus (white arrow).. MRI: magnetic resonance imaging. CVST: cerebral venous sinus thrombosis. GAD: Gadolinium contrast
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case_images: PMC9981213_01_cureus-0015-00000034453-i03.jpg
case_images: FIG3
case_images: Her initial MRI brain revealed pre- and post-septal orbital cellulitis with focal infarction, hyperdense fragments along the lateral orbit which were suspected to be foreign bodies, a linear non-displaced fracture of the posterolateral wall of her right orbit and a filling defect along the anterior and mid aspect of the right cavernous sinus representing a right CSVT (Figure 3).
case_images: MRA of CCF: Oblique 3D time-of-flight MRA demonstrates narrowing of the right ICA (white arrow). Focal outpouching extending from ICA (open arrow) reflects the CCF.. MRA: magnetic resonance angiography. CCF: caroticocavernous fistula. ICA: internal carotid artery
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case_images: PMC9981213_01_cureus-0015-00000034453-i04.jpg
case_images: FIG4
case_images: The MRA showed a narrowing of the right internal carotid artery (ICA) and focal outpouching from ICA reflecting the CCF (Figure 4).