1
|
Caiza-Zambrano F, Gómez Lastra M, Garbugino S, Gonzalez FM, Galarza Menoscal J, Benetti M, Neme Segura Y, Miquelini LA, Uribe-Roca C, Fernández-Pardal M, León-Cejas L, Reisin R, Bonardo P. High-flow carotid cavernous fistula and 'white eye': A rare and easily misdiagnosed presentation - A case report and literature review. J R Coll Physicians Edinb 2024:14782715241246572. [PMID: 38634267 DOI: 10.1177/14782715241246572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/19/2024] Open
Abstract
The three classic symptoms of carotid cavernous fistula (CCF) are pulsating exophthalmos, bruit and conjunctival chemosis. Here, we present a clinical case of isolated abducens nerve palsy due to a high-flow CCF in an 84-year-old woman, without the typical congestive orbito-ocular features. It was a diagnostic challenge because, for patients older than 50 years with cardiovascular risk factors, ischaemic mononeuropathy is the most frequent aetiology. This case illustrates the least common type of CCF that can be easily misdiagnosed. Physicians should consider fistula as a possible diagnosis in a patient with isolated abducens nerve palsy even without the classic triad.
Collapse
Affiliation(s)
| | | | - Silvia Garbugino
- Department of Interventional Neuroradiology, Hospital Británico de Buenos Aires, Argentina
| | | | | | - Mauricio Benetti
- Department of Neurology, Hospital Británico de Buenos Aires, Argentina
| | | | | | | | | | | | - Ricardo Reisin
- Department of Neurology, Hospital Británico de Buenos Aires, Argentina
| | - Pablo Bonardo
- Department of Neurology, Hospital Británico de Buenos Aires, Argentina
| |
Collapse
|
2
|
Kalaichandran S, Micieli JA. Bilateral sixth nerve palsies from carotid cavernous fistulas with transient worsening following transvenous embolisation. BMJ Case Rep 2019; 12:12/11/e232191. [PMID: 31712243 DOI: 10.1136/bcr-2019-232191] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
A 59-year-old man presented with a 2-week history of binocular horizontal diplopia worse when looking to the left. He was diagnosed with a left sixth nerve palsy (6 NP) and had new bilateral findings at a 2-week follow-up with new dilated episcleral blood vessels. Bilateral carotid-cavernous fistulas (CCFs) were suspected and confirmed with CT angiography and catheter angiography. He underwent successful coil and Onyx embolisation of the left cavernous sinus and immediately noticed worsening of the double vision when looking left due to a worse left 6 NP. Three weeks later, he underwent similar treatment of the right CCF and immediately noticed worsening of the double vision when looking to the right and was found to have a worse right 6 NP. His double vision resolved 6 months later. CCFs are rare causes of bilateral 6 NPs and although there is a good prognosis, symptoms may worsen after treatment.
Collapse
Affiliation(s)
| | - Jonathan A Micieli
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada .,Division of Neurology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| |
Collapse
|
3
|
Leishangthem L, Satti SR. Indirect carotid cavernous fistula mimicking ocular myasthenia. BMJ Case Rep 2017; 2017:bcr-2017-222048. [PMID: 29054956 DOI: 10.1136/bcr-2017-222048] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
71-year-old woman with progressive left-sided, monocular diplopia and ptosis. Her symptoms mimicked ocular myasthenia, but she had an indirect carotid cavernous fistula (CCF). She was diagnosed with monocular myasthenia gravis (negative acetylcholinesterase antibody) after a positive ice test and started on Mestinon and underwent a thymectomy complicated by a brachial plexus injury. Months later, she developed left-sided proptosis and ocular bruit. She was urgently referred to neuro-interventional surgery and was diagnosed with an indirect high-flow left CCF, which was treated with Onyx liquid and platinum coil embolisation. Mestinon was discontinued. Her ophthalmic symptoms resolved. However, she was left with a residual left arm and hand hemiparesis and dysmetria secondary to a brachial plexus injury. Indirect CCF usually can present with subtle and progressive symptoms leading to delayed diagnosis or misdiagnosis. It is important for ophthalmologists to consider this differential in a patient with progressive ocular symptoms.
Collapse
Affiliation(s)
- Lakshmi Leishangthem
- Department of Neurology, Albert Einstein Medical Center, Philadelphia, Pennsylvania, USA
| | - Sudhakar Reddy Satti
- Department of Neurointerventional Surgery, Christiana Care Health Center, Newark, Delaware, USA
| |
Collapse
|
4
|
Bunch PM. Anatomic Eponyms in Neuroradiology: Head and Neck. Acad Radiol 2016; 23:1319-32. [PMID: 27283070 DOI: 10.1016/j.acra.2016.04.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2016] [Revised: 04/17/2016] [Accepted: 04/19/2016] [Indexed: 10/21/2022]
Abstract
In medicine, an eponym is a word-typically referring to an anatomic structure, disease, or syndrome-that is derived from a person's name. Medical eponyms are ubiquitous and numerous. They are also at times controversial. Eponyms reflect medicine's rich and colorful history and can be useful for concisely conveying complex concepts. Familiarity with eponyms facilitates correct usage and accurate communication. In this article, 22 eponyms used to describe anatomic structures of the head and neck are discussed. For each structure, the author first provides a biographical account of the individual for whom the structure is named. An anatomic description and brief discussion of the structure's clinical relevance follow.
Collapse
|
5
|
Adam MK, Krespan K, Moster ML, Sergott RC. Simultaneous, Bilateral Ophthalmoplegia as the Presenting Sign of Paediatric Multiple Sclerosis: Case Report and Discussion of the Differential Diagnosis. Neuroophthalmology 2014; 38:230-237. [DOI: 10.3109/01658107.2014.902972] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2014] [Revised: 02/25/2014] [Accepted: 02/25/2014] [Indexed: 12/18/2022] Open
|
6
|
Albert GW, Dahdaleh NS, Hasan DM. Direct carotid-cavernous fistula presenting with minimal symptoms and rapid angiographic progression. J Clin Neurosci 2010; 17:1187-9. [PMID: 20605465 DOI: 10.1016/j.jocn.2009.12.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2009] [Accepted: 12/16/2009] [Indexed: 11/30/2022]
Abstract
Most patients with direct carotid-cavernous fistulas (CCFs) present with dramatic symptoms including proptosis, chemosis, and diplopia. We report a patient with a direct/high-flow CCF whose only initial symptom was pulse-synchronous tinnitus. Following diagnostic angiography, she developed mild symptoms and dramatic angiographic changes over a period of 3 days. Complete occlusion of the CCF and resolution of her symptoms were achieved by performing a stent-assisted coil embolization.
Collapse
Affiliation(s)
- Gregory W Albert
- Department of Neurosurgery, University of Iowa Hospital and Clinics, 200 Hawkins Drive, Iowa City, IA 52242, USA
| | | | | |
Collapse
|
7
|
Chang JH, Shin YB, Sohn HJ, Ko HY, Lee TH, Ha YH. Isolated bilateral abducens nerves palsy due to traumatic delicate arteriovenous fistula. Brain Inj 2009; 24:46-9. [PMID: 20001482 DOI: 10.3109/02699050903409854] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Ocular motor dysfunction is common in patients with head trauma. Also, traumatic lateral gaze palsy is usually associated with brain stem lesion, peripheral nerve injury with or without basilar skull fracture and lateral rectus muscle injury or entrapment. However, isolated bilateral abducens nerve palsy is extremely rare. CASE STUDY This study describes a case of isolated bilateral abducens nerve palsy in a 35-year-old male with head trauma without cervical and skull fractures. He was diagnosed with mild diffuse axonal injury. During his assessment, he developed mild limb weakness, an ataxic gait and impaired abductive movement in both eyes. Angiography of the left common carotid artery revealed multiple small arteriovenous fistulae in both inferior nasal conchae. After embolization, lateral gaze palsy of his eyes was significantly improved. CONCLUSIONS Based on this case, arteriovenous fistula should be considered as a cause of bilateral isolated abducens nerve palsy.
Collapse
Affiliation(s)
- Jae Hyeok Chang
- Department of Rehabilitation Medicine, Pusan National University Hospital, Pusan National University School of Medicine, Seo-gu, Busan, Republic of Korea
| | | | | | | | | | | |
Collapse
|
8
|
Lin CM, Hseu IH. Isolated Trochlear Nerve Palsy Associated with Carotid–Cavernous Sinus Fistula. INT J GERONTOL 2009. [DOI: 10.1016/s1873-9598(09)70034-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
|
9
|
Wu HC, Ro LS, Chen CJ, Chen ST, Lee TH, Chen YC, Chen CM. Isolated ocular motor nerve palsy in dural carotid-cavernous sinus fistula. Eur J Neurol 2006; 13:1221-5. [PMID: 17038036 DOI: 10.1111/j.1468-1331.2006.01478.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The incidence of dural carotid-cavernous sinus fistula (DCCF) presenting as isolated ocular motor nerve palsies without congestive ocular features is unknown. We reviewed the DCCF patients in our hospital during the last 10 years to elucidate the clinical and neuroradiological features of DCCF with isolated ocular motor nerve palsy. Eleven amongst the 33 DCCF patients presented isolated ocular motor nerve palsy. All the 11 patients underwent brain CT/CT angiography (CTA) and/or MRI/MR angiography (MRA), before the digital subtraction angiography (DSA). The compromised nerves were the oculomotor nerve in eight (72.7%), abducens nerve in two (18.2%) and trochlear nerve in one (9.1%). Brain CT and/or CTA were conducted in four patients but all unremarkable. MRI and/or MRA were performed in nine patients and six of them showed compatible findings of DCCF. The diagnoses of DCCFs were confirmed by DSA and all were posterior-draining type. The outcome was good, with a total recovery rate of 54.5% within 12 months. Thirty-three percent (11 of 33) of our DCCF patients presented with isolated ocular motor nerve palsy, which is not uncommon. MRI and MRA are of value in the initial evaluation, but DSA is necessary for the accurate diagnosis and treatment planning.
Collapse
Affiliation(s)
- H-C Wu
- Department of Neurology, Chang Gung Memorial Hospital, Taipei, Taiwan
| | | | | | | | | | | | | |
Collapse
|
10
|
Sollberger M, Lyrer P, Baumann T, Radü EW, Steck AJ, Wetzel SG. Isolated bilateral abducent nerve palsy due to a spontaneous left-side dural carotid cavernous fistula Type Barrow C. J Neurol 2005; 252:372-3. [PMID: 15791389 DOI: 10.1007/s00415-005-0657-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2004] [Revised: 09/07/2004] [Accepted: 09/10/2004] [Indexed: 10/25/2022]
|
11
|
Abstract
Neurologists should be aware of the following causes of eye pain: (1)ocular and orbital disorders with or without visible pathology of the eye (eg,redness, corneal opacity, or proptosis); (2) ophthalmologic syndromes associated with headache; and (3) headache syndromes associated with ophthalmologic findings.
Collapse
Affiliation(s)
- Andrew G Lee
- Department of Ophthalmology, 200 Hawkins Drive, Pomerantz Family Pavillion, University of Iowa Hospitals and Clinics, Iowa City, IA 52242, USA.
| | | | | |
Collapse
|
12
|
Brazis PW, Lee AG, Stewart M, Capobianco D. Clinical review: the differential diagnosis of pain in the quiet eye. Neurologist 2002; 8:82-100. [PMID: 12803694 DOI: 10.1097/00127893-200203000-00003] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Eye pain, periorbital and retro-orbital pain, and headache or facial pain referred to the orbital region are common presenting complaints. REVIEW SUMMARY In this review, we discuss the etiologies of eye pain in the quiet eye, which is defined clinically as one with a clear cornea without redness or irritation of the conjunctiva or sclera. CONCLUSIONS The causes of eye pain may be divided into two groups: (1) those associated with abnormal localizing ophthalmologic and neuro-ophthalmologic findings (including trigeminal neuropathies);(2) those with a normal ophthalmologic and neurologic examinations. The latter group is further divided into the following subgroups: (1) specific short-lasting or long-lasting headache or eye pain syndromes; (2) pain referred to the eye from other pathologic processes (secondary eye pain) sometimes distant from structures concerned with vision; and (3) pain from orbital, superior orbital fissure, cavernous sinus, or intracranial infiltrative, neoplastic, or inflammatory disease processes with normal ophthalmologic and neuro-ophthalmologic exam. Unfortunately, in some patients, no etiology for the pain syndrome is discerned and one is left with a diagnosis of idiopathic eye pain, eye strain, or atypical facial pain.
Collapse
Affiliation(s)
- Paul W Brazis
- Department of Neurology, Mayo Clinics-Jacksonville, Jacksonville, Florida 32224, USA.
| | | | | | | |
Collapse
|