Li Shan, Feng Bin, Feng Yabo, Pang Zaiying, Lin Youting
Department of Neurology, Shandong Provincial Hospital affiliated to Shandong University, No 324, Jingwu Road, Huaiyin Zone, Jinan, Shandong Province, 250012, People's Republic of China.
Department of Neurosurgery, Shandong Provincial Hospital affiliated to Shandong University, Jinan, Shandong Province, People's Republic of China.
BMC Ophthalmol. 2019 Feb 11;19(1):48. doi: 10.1186/s12886-019-1039-8.
Painful ophthalmoplegia can be caused by various etiologies, and broad differential diagnosis is needed. Carotid-cavernous fistula (CCF) is a rare cause of painful ophthalmoplegia, and early diagnosis is quite difficult.
Here, we present a case of paroxysmal painful ophthalmoplegia caused by CCF. The episodic symptoms were nonstereotypical and lasted minutes to hours. Magnetic resonance imaging (MRI) and computed tomography angiography (CTA) results were normal, which confounded efforts to determine a diagnosis. Subsequently, digital subtraction angiography (DSA) revealed a posterior-draining CCF. The CCF was treated at an early stage without residual symptoms.
We propose that symptoms could be relapsing or remitting during an early stage of CCF and that posterior-draining CCF is prone to misdiagnosis due to atypical manifestations. Normal CTA results cannot exclude carotid-cavernous fistula, and DSA should be performed once CCF is suspected.
疼痛性眼肌麻痹可由多种病因引起，需要进行广泛的鉴别诊断。颈动脉海绵窦瘘（CCF）是疼痛性眼肌麻痹的罕见病因，早期诊断相当困难。
在此，我们报告一例由CCF引起的阵发性疼痛性眼肌麻痹病例。发作性症状不典型，持续数分钟至数小时。磁共振成像（MRI）和计算机断层血管造影（CTA）结果正常，这给诊断带来了困扰。随后，数字减影血管造影（DSA）显示为后引流型CCF。该CCF在早期得到治疗，无残留症状。
我们提出，在CCF早期症状可能会复发或缓解，并且后引流型CCF由于表现不典型容易误诊。CTA结果正常不能排除颈动脉海绵窦瘘，一旦怀疑CCF应进行DSA检查。
