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Neurology
Transient fourth nerve palsy preceding cervical myelopathy due to carotid-cavernous fistula
  1. Veronica Viola1,
  2. Claudia Faini1,
  3. Carlo Bortolotti2,
  4. Maria Guarino3,
  5. Luigi Cirillo1,4 and
  6. Rita Rinaldi3
  1. 1DIBINEM - Dipartimento di Scienze Biomediche e Neuromotorie, Università di Bologna, Bologna, Italy
  2. 2UOC Neurochirurgia, IRCSS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
  3. 3UOC Clinica Neurologica – Rete Neurologica Metropolitana (NEUROMET), Policlinico Sant’Orsola- Malpighi, IRCCS Istituto Delle Scienze Neurologiche di Bologna, Bologna, Italy
  4. 4Unità di Neuroradiologia, IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
  1. Correspondence to Dr Luigi Cirillo; luigi.cirillo2{at}unibo.it

Abstract

Carotid-cavernous fistulas (CCFs) are rare intracranial vascular malformations. Among the various classifications available, the most recently proposed highlights the strong correlation between venous drainage pattern and clinical presentation. We present the case of a woman in her 70s with a history of transient palsy of the fourth cranial nerve who presented with subacute cervical myelopathy, which was caused by a CCF with venous drainage into the peribulbar and perimedullary plexus.

Given this atypical presentation of CCF and the diagnostic challenges it poses, we conducted a comprehensive PubMed search looking for CCFs presenting with cervical myelopathy and our results confirmed their rarity and allowed us to identify clinical elements that may help clinicians diagnose and manage this potentially treatable condition.

  • Spinal cord
  • Stroke
  • Neuroimaging
  • Interventional radiology

https://doi.org/10.1136/bcr-2024-260333

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    Footnotes

    • Contributors The following authors were responsible for drafting of the text, sourcing and editing of clinical images, investigation results, drawing original diagrams and algorithms and critical revision for important intellectual content: VV, CF, CB, MG, LC and RR. The following authors gave final approval of the manuscript: VV, CF, CB, MG, LC and RR.

    • 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.

    • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

    • Competing interests None declared.

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

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.