A case of dural arteriovenous fistula of right cavernous sinus presenting bilateral eye symptoms

Abstract

An 85-year-old woman was first admitted to our hospital because of right ptosis and diplopia. Examinations showed right oculomotor paralysis and reduced vision in the right eye. Serological and neuroradiological examinations failed to reveal the etiology. Oral prednisolone was started for a presumptive diagnosis of idiopathic oculomotor nerve palsy, which resulted in little improvement. Approximately ten months after the first admission, left ptosis appeared and she was re-admitted to our hospital. One day after admission, external ophthalmoplegia and conjunctival injection on the left side appeared. MRI revealed abnormal flow void in the right cavernous sinus. Based on cerebral angiographic findings, dural arteriovenous fistula of the right cavernous sinus was diagnosed. Symptoms on the left side were considered to result from increased perfusion pressure due to venous drainage via the intercavernous sinus to the contralateral cavernous sinus. After transvenous embolization, symptoms and signs improved gradually. In a case of external ophthalmoplegia with unknown etiology, detailed neuroradiologyical examinations such as cerebral angiogram are advisable.

Extracranial arteriovenous malformation and subsequent contralateral cavernous sinus dural arteriovenous fistula showing abducens nerve palsy: illustrative case

“…Also, there are case reports in which dAVF in the CS on one side caused increased bilateral intracavernous pressure, resulting in bilateral ocular symptoms. 8 Therefore, in our case, the right CS dAVF appears to have resulted from increased intracavernous pressure due to drainage from the left pterygoid AVM. Spontaneous regression of the AVM reduced the intracavernous pressure and caused amelioration of the symptoms.…”

“…There was no evidence in the radiological findings that could directly explain the left abducens nerve palsy. However, Yokokawa et al 8 reported a case in which dAVF led to an increase in pressure in the CS on one side, causing cranial nerve symptoms on the opposite side. Pressure increase in the left CS is necessary to explain the occurrence of the left abducens nerve palsy.…”