Delayed Onset Abducens Nerve Palsy and Horner Syndrome after Treatment of a Traumatic Carotid-cavernous Fistula

Won Jae Kim; Cheol Won Moon; Myung Mi Kim

doi:10.3341/jkos.2019.60.9.905

Journal List > J Korean Ophthalmol Soc > v.60(9) > 1133046

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Kim, Moon, and Kim: Delayed Onset Abducens Nerve Palsy and Horner Syndrome after Treatment of a Traumatic Carotid-cavernous Fistula

Case Report

Journal of the Korean Ophthalmological Society 2019; 60(9): 905-908.

Published online: 18 September 2019

DOI: https://doi.org/10.3341/jkos.2019.60.9.905

Delayed Onset Abducens Nerve Palsy and Horner Syndrome after Treatment of a Traumatic Carotid-cavernous Fistula

Won Jae Kim, MD, Cheol Won Moon, MD, Myung Mi Kim, MD, PhD

Department of Ophthalmology, Yeungnam University College of Medicine, Daegu, Korea.

Address reprint requests to Myung Mi Kim, MD, PhD. Department of Ophthalmology, Yeungnam University Hospital, #170 Hyeonchung-ro, Nam-gu, Daegu 42415, Korea. Tel: 82-53-620-3441, Fax: 82-53-626-5936, mmk@med.yu.ac.kr

Received 12 February 2019 Revised 12 March 2019 Accepted 16 August 2019

The Korean Ophthalmological Society

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

We report a patient with delayed-onset abducens nerve palsy and Horner syndrome after endovascular treatment of traumatic carotid-cavernous fistula (CCF).

Case summary

A 68-year-female visited our ophthalmic department complaining of gradual-onset ptosis of the left eye and horizontal diplopia. She had undergone endovascular treatment to treat left-sided traumatic CCF after a car accident 10 years before; she had been told at that time that the treatment outcome was favorable. The left-sided ptosis gradually developed 6 years after the procedure, accompanied by diplopia. The left eye exhibited miosis and the extent of anisocoria increased in dim light. An extraocular examination revealed 30 prism diopters of left esotropia in the primary gaze and a −4 abduction limitation of the left eye. CCF recurrence was suspected; however, magnetic resonance imaging with magnetic resonance angiography of brain did not support this. The esotropia did not improve during the 6-month follow-up and strabismus surgery was performed.

Conclusions

Delayed-onset abducens nerve palsy and Horner syndrome can develop even after successful endovascular treatment of CCF. Strabismus surgery should be considered in patients whose diplopia does not spontaneously improve.

Keywords: Abducens nerve diseases, Carotid-cavernous sinus fistula, Horner syndrome

Figures and Tables

Figure 1

(A) and (B). Images of 68-year-old female who underwent endovascular treatment for left traumatic carotid-cavernous fistula 10 years ago. The patient demonstrated left-sided ptosis (A). The left eye showed miosis (B, arrow). The anisocoria increased in dim light, suggesting the left Horner syndrome.

Figure 2

Images of the patient in nine diagnostic position of gaze. The patient showed 30 prism diopters left esotropia at primary gaze and −4 abduction limitation of the left eye with ptosis.

Notes

^{Conflicts of Interest} The authors have no conflicts to disclose.

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