A 86-year old woman was presented with sudden left side weakness and diplopia. Brain magnetic resonance image showed acute lesions in the right middle cerebral artery territory. In T2 weighted image, dilatations of left superior ophthalmic vein and cavernous sinus were detected. Digital subtraction angiography revealed left dural carotid cavernous fistula classified as Barrow type D. Instead of embolization of the fistula, a manual compression of carotid artery and jugular vein was applied by guiding with transcranial Doppler (TCD). After 4 months, superior ophthalmic venous flow was disappeared and left eye gaze palsy was resolved. TCD guided carotid manual compression can be easily and safely applied to patient with dural carotid cavernous fistula. Journal of Neurosonology 8(2):45-48, 2016 Key Words: Dural carotid cavernous fistula, Abducens nerve, Transcranial Doppler ultrasonography