J Korean Soc Radiol.  2012 Oct;67(4):227-230. 10.3348/jksr.2012.67.4.227.

Isolated Oculomotor Nerve Palsy Caused by Cavernous Sinus Dural Arteriovenous Fistula: Case Report

• Ihn YK
• Jung WS
• Kim BS

• KMID: 1439530
• DOI: http://doi.org/10.3348/jksr.2012.67.4.227

Abstract

Cavernous dural arteriovenous fistula (DAVF), which usually presents with conjunctival injection, proptosis, loss of visual acuity, and ophthalmoplegia, is a rare cause of ophthalmoplegia. Thus, it may be overlooked when the typical symptoms are lacking. There have been some cavernous DAVF case reports presenting with isolated oculomotor, abducens and trochlear nerve palsy. We report a patient presenting with isolated oculomotor palsy, caused by cavernous DAVF, which was treated by transvenous coil embolization. This case suggests that cavernous DAVF should be considered in the differential diagnosis of isolated oculomotor nerve palsy and for which case - selective angiography and embolization may be helpful in reaching a diagnosis and providing a guide for optimal treatment.

MeSH Terms

Angiography
Cavernous Sinus
Caves
Central Nervous System Vascular Malformations
Diagnosis, Differential
Exophthalmos
Humans
Oculomotor Nerve
Oculomotor Nerve Diseases
Ophthalmoplegia
Paralysis
Trochlear Nerve Diseases
Visual Acuity

Figure

• 

  Fig. 1 A 76-year-old female patient with a cavernous dural arteriovenous fistula. A. An axial CT source image shows asymmetrical contrast filling in the left cavernous sinus, especially, in the posterior aspect of the cavernous sinus (arrow). B. Time-resolved contrast MRA images show a rapid arterial phase filling of both the left cavernous sinus (arrowhead) and the inferior petrosal sinus (arrow) because of the left cavernous dural arteriovenous fistula. C. Left internal carotid angiography shows early filling of the superoposterior cavernous sinus (arrow) with drainage into the inferior petrosal sinus. Note that the superior ophthalmic vein was not visualized. D. Left external carotid angiography shows a cavernous dural arteriovenous fistula, supplied by a recurrent meningeal artery (arrow) from the middle meningeal artery, and with drainage into the inferior petrosal sinus. E. Left common carotid angiography demonstrates complete occlusion of the fistula. Note.-MRA = magnetic resonance angiography

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