Rinsho Shinkeigaku (Clinical Neurology)

Case Report

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

Kazuki Yokokawa, M.D.1), Mai Fujikura, M.D.1), Hirohiko Shizukawa, M.D.1), Akira Takahashi, M.D.2) and Shun Shimohama, M.D., Ph.D.3)

1)Department of Neurology, Sapporo Kosei General Hospital
2)Department of Neurosurgery, Sapporo Shiroishi Memorial Hospital
3)Department of Neurology, Sapporo Medical University School of Medicine

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.
Full Text of this Article in PDF (729K)

(CLINICA NEUROL, 55: 828|832, 2015)
key words: dural arteriovenous fistula, cavernous sinus, oculomotor nerve, external ophthalmoplegia, MRI

(Received: 31-Mar-15)