J Korean Ophthalmol Soc.  2019 Sep;60(9):905-908. 10.3341/jkos.2019.60.9.905.

Delayed Onset Abducens Nerve Palsy and Horner Syndrome after Treatment of a Traumatic Carotid-cavernous Fistula

Affiliations
  • 1Department of Ophthalmology, Yeungnam University College of Medicine, Daegu, Korea. mmk@med.yu.ac.kr

Abstract

PURPOSE
We report a patient with delayed-onset abducens nerve palsy and Horner syndrome after endovascular treatment of traumatic carotid-cavernous fistula (CCF). CASE SUMMARY: A 68-year-female visited our ophthalmic department complaining of gradual-onset ptosis of the left eye and horizontal diplopia. She had undergone endovascular treatment to treat left-sided traumatic CCF after a car accident 10 years before; she had been told at that time that the treatment outcome was favorable. The left-sided ptosis gradually developed 6 years after the procedure, accompanied by diplopia. The left eye exhibited miosis and the extent of anisocoria increased in dim light. An extraocular examination revealed 30 prism diopters of left esotropia in the primary gaze and a −4 abduction limitation of the left eye. CCF recurrence was suspected; however, magnetic resonance imaging with magnetic resonance angiography of brain did not support this. The esotropia did not improve during the 6-month follow-up and strabismus surgery was performed.
CONCLUSIONS
Delayed-onset abducens nerve palsy and Horner syndrome can develop even after successful endovascular treatment of CCF. Strabismus surgery should be considered in patients whose diplopia does not spontaneously improve.

Keyword

Abducens nerve diseases; Carotid-cavernous sinus fistula; Horner syndrome

MeSH Terms

Abducens Nerve Diseases*
Abducens Nerve*
Anisocoria
Brain
Carotid-Cavernous Sinus Fistula
Diplopia
Esotropia
Fistula*
Follow-Up Studies
Horner Syndrome*
Humans
Magnetic Resonance Angiography
Magnetic Resonance Imaging
Miosis
Recurrence
Strabismus
Treatment Outcome
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