Paradoxical Worsening Ocular Movement in Idiopathic Carotid-Cavernous Fistula without Conjunctival Congestion - Case Report

Abstract

We report a case of carotid-cavernous fistula (CCF) without conjunctival congestion and showing radiographically paradoxical worsening ocular movement. A 71-year-old woman suffered from mild double vision. The first carotid angiogram revealed left CCF, which was supplied by dural branches of the internal and external carotid arteries and drained out well via only the superior orbital vein to the angular vein. We did not perform intravascular intervention because of spontaneous improving of her symptom. However, three weeks after her discharge, her symptom began worsing and she was readmitted because of left complete ophthalmoplegia, but without conjunctival congestion. Contrary to our expectation the second left carotid angiogram demonstrated that the shunt flow to the angular vein of CCF was much less than that seen previously. After transvenous embolization of the left cavernous sinus, her symptom completely improved and CCF did not recur.