Chan Chung Charles, Wen David Wei, Chew Tricia Li Ting, See Siew Ju
Department of Neurology, National Neuroscience Institute, Duke-NUS Medical School.
Department of Diagnostic Radiology, Singapore General Hospital, Singapore.
Neurologist. 2023 Jan 1;28(1):49-53. doi: 10.1097/NRL.0000000000000437.
The approach to oculomotor nerve palsies involves the exclusion of compressive, infective, inflammatory, or ischemic lesions. Dural arteriovenous fistulae, including carotid-cavernous fistulae (CCF), are known causes of third nerve palsy. However, diagnosis can sometimes be delayed or missed due to the various clinical presentations. CCF remains a rare but treatable cause of third nerve palsy.
A 63-year-old Chinese female presented to our unit with gradual onset horizontal diplopia. Clinical examination revealed a partial left oculomotor nerve palsy without congestive eye symptoms. A cerebral angiogram revealed a left indirect CCF supplied by the inferolateral trunk of the left internal carotid artery. She underwent successful transvenous embolization. She improved postprocedure and was discharged well on day 10 of her admission. She was reviewed at 2 months follow-up and had recovered completely.
Our case is a classic description of a CCF with posterior drainage into the inferior petrosal sinus. We hope this case and a review of the literature can serve as a reminder to clinicians of the varied presentations of CCF. We believe this case adds value to the clinicians in contributing to their diagnostic process and to our interventional colleagues in highlighting a case with a successful postembolization outcome.
动眼神经麻痹的诊疗方法包括排除压迫性、感染性、炎性或缺血性病变。硬脑膜动静脉瘘，包括颈内动脉海绵窦瘘（CCF），是导致动眼神经麻痹的已知病因。然而，由于临床表现多样，有时诊断会延迟或漏诊。CCF仍然是动眼神经麻痹的一种罕见但可治疗的病因。
一名63岁中国女性因逐渐出现水平性复视而就诊于我院。临床检查发现左侧动眼神经部分麻痹，无眼部充血症状。脑血管造影显示左侧间接CCF，由左颈内动脉下外侧干供血。她接受了成功的经静脉栓塞治疗。术后病情改善，入院第10天顺利出院。2个月随访时复查，已完全康复。
我们的病例是CCF经岩下窦后引流的典型描述。我们希望这个病例及文献复习能提醒临床医生注意CCF的多种表现形式。我们相信这个病例对临床医生的诊断过程有帮助，也为介入治疗的同行提供了一个栓塞后成功治愈的案例。
