A Case of Cavernous Sinus Dural Arteriovenous Fistula Following Tolosa-Hunt Syndrome.
10.3341/jkos.2016.57.6.977
- Author:
Aram PARK
1
;
Seung Woo KIM
;
Seung Ah CHUNG
Author Information
1. Department of Ophthalmology, Ajou University School of Medicine, Suwon, Korea. mingming8@naver.com
- Publication Type:Case Report
- Keywords:
Cavernous sinus;
Dural arteriovenous fistula;
Tolosa-Hunt syndrome
- MeSH:
Adrenal Cortex Hormones;
Angiography;
Blepharoptosis;
Cavernous Sinus*;
Central Nervous System Vascular Malformations*;
Cerebral Angiography;
Diagnosis;
Diplopia;
Embolization, Therapeutic;
Exophthalmos;
Exotropia;
Female;
Follow-Up Studies;
Humans;
Hypertension;
Inflammation;
Magnetic Resonance Imaging;
Middle Aged;
Oculomotor Nerve Diseases;
Orbit;
Pupil;
Recurrence;
Strabismus;
Tolosa-Hunt Syndrome*
- From:Journal of the Korean Ophthalmological Society
2016;57(6):977-982
- CountryRepublic of Korea
- Language:Korean
-
Abstract:
PURPOSE: To report a case of cavernous sinus dural arteriovenous fistula following Tolosa-Hunt syndrome. CASE SUMMARY: A 64-year-old female with a history of hypertension, presented with blepharoptosis and periorbital pain in the right eye and diplopia. Her right pupil was dilated. She had right exotropia and right hypertropia with inability to elevate, depress, and adduct the right eye. Magnetic resonance imaging including angiography, revealed hyperintensities in the right cavernous sinus consistent with inflammation and no vascular abnormalities. Three days after oral corticosteroid therapy, the pain disappeared. A presumptive diagnosis was Tolosa-Hunt syndrome presenting as a form of complete oculomotor nerve palsy. Two months later, she experienced severe pain in the right periocular area, even though blepharoptosis was resolved and ocular motility was improved. A rapid response to high-dose intravenous corticosteroids was consistent with recurrence of Tolosa-Hunt syndrome. Three months later, she had normal ocular motility, but developed a conjunctival injection, pulsatile orbital bruits, and exophthalmos in the right eye. Cerebral angiography showed a cavernous sinus dural arteriovenous fistula. She received a transvenous coil embolization and her symptoms markedly improved over 2 months. CONCLUSIONS: Tolosa-Hunt syndrome, a granulomatous inflammation in the cavernous sinus may be followed by cavernous sinus dural arteriovenous fistula and should be considered during follow-up.
