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Isolated contralateral abducens palsy in direct carotid-cavernous fistula
  1. Chirag Jain1,
  2. Aditi Mehta2,
  3. Vikas Bhatia3 and
  4. Pankaj Gupta4
  1. 1Radiodiagnosis and Imaging, Post Graduate Institute of Medical Education and Research, Chandigarh, India
  2. 2Ophthalmology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
  3. 3Radiodiagnosis, Post Graduate Institute of Medical Education and Research, Chandigarh, India
  4. 4Advanced Eye Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
  1. Correspondence to Dr Aditi Mehta; aditimehta7{at}gmail.com

Abstract

Post-traumatic direct carotid-cavernous fistulas may develop in patients with a closed head injury. The classical presentation is the Dandy’s triad—chemosis, pulsatile proptosis and orbital bruit. Associated findings may include orbital pain, dilated episcleral corkscrew vessels, vision deficit and cranial nerve palsies. Cranial nerves—oculomotor (III), trochlear (IV), ophthalmic (V1), and maxillary (V2) divisions of trigeminal and the abducens (VI) lie in close association of the cavernous sinus. Abducens nerve (VI) lies close to the intracavernous internal carotid artery, within the substance of the sinus and is hence easily susceptible to vascular insult. The two sinuses connect across the midline and communicate freely with each other. Back pressure changes can present with the same sided or bilateral cranial nerve palsies. We report a rare association of a long-standing left-sided carotid-cavernous fistula with right eye abduction deficit and contralateral abducens palsy.

  • cranial nerves
  • neuroimaging
  • neuro-opthalmology
  • trauma CNS /PNS
  • ophthalmology

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Footnotes

  • Contributors CJ: concept, patient management, manuscript preparation and data collection. AM: concept and design, literature review, manuscript preparation and patient management. VB: concept, patient management, manuscript review and supervision. PG: patient management and manuscript review.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Parental/guardian consent obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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