Ophthalmoplegia consistent with a pulse is one of the symptoms of direct carotid cavernous sinus fistula. A few direct carotid cavernous fistulas are spontaneous, mostly due to a ruptured aneurysm of the cavernous segment of the internal carotid artery, and can be indistinguishable from a traumatic one on angiography. What are the symptoms that are easily confused with it? The typical manifestation of pediatric ataxia capillaris syndrome is that the head turns faster than the eye when the patient looks at a fast-moving object. 2. Ocular convergence paralysis or spasm Most commonly seen in pineal cell tumor eye syndrome, in addition to the inability to look upward, it is also accompanied by altered pupillary light response, ocular convergence paralysis or spasm, and nystagmus. This suggests damage around the aqueduct (including the anterior part of the aqueduct and the lower posterior part of the third ventricle). 3, the eye regulation function is reduced or disappeared The eye, like the brain, is an organ rich in nerves and blood vessels, and undertakes extremely complex physiological functions. In order to see the target at a close distance, the contraction of the ciliary muscle in the eye increases the curvature of the lens in the eye, thus enhancing the refractive power of the eye and making a clear image of the object at a close distance on the retina. The diminished or absent regulation of the eye can cause vision loss. With the improvement of interventional embolization techniques, the treatment of direct carotid cavernous sinus fistula has been greatly improved and the incidence of complications has been greatly reduced. No special prevention modality is available, and attention is paid to trauma.