The occurrence of fatal epistaxis accompanying carotid-cavernous fistula is rare. This case represents the typical features of it. A 29-year-old man had a crushing frontal head injury by an ax on June 28, 1980. Thereafter, he suffered from repeated bouts of epistaxis, headache, visual loss and impaired ocular movement regardless of the proper neurosurgical and plastic management. On the post-trauma 130th day, he had massive epistaxis and was transfused with 15 pints of whole blood to combat hypovolemia and for resuscitation. Orbital bruits and proptosis were also noticed and emergency carotid angiogram revealed a carotid-cavernous fistula. Embolization with a muscle piece was performed unsuccessfully. Because of an extended aneurysm, contralateral blindness was also developed. On the post-trauma 180th day, he died of aneurysmal rupture and sepsis.