Delayed Onset Abducens Nerve Palsy and Horner Syndrome after Treatment of a Traumatic Carotid-cavernous Fistula
10.3341/jkos.2019.60.9.905
- Author:
Won Jae KIM
1
;
Cheol Won MOON
;
Myung Mi KIM
Author Information
1. Department of Ophthalmology, Yeungnam University College of Medicine, Daegu, Korea. mmk@med.yu.ac.kr
- Publication Type:Case Report
- Keywords:
Abducens nerve diseases;
Carotid-cavernous sinus fistula;
Horner syndrome
- MeSH:
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
- From:Journal of the Korean Ophthalmological Society
2019;60(9):905-908
- CountryRepublic of Korea
- Language:Korean
-
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.
