Unveiling uncommon connections: Posterior drainage carotid cavernous fistula presenting as isolated oculomotor palsy
Arpit Agrawal1
, Chandradev Sahu2, Abhijeet Kumar Kohat1, Anam Fatima2, Manisha Gupta1
1Department of Neurology, DKSPGI (Dau Kalyan Singh Postgraduate Institute), Raipur, Chhattisgarh, India
2Department of Radiology, PTJNMMC (Pandit Jawahar Lal Nehru Medical College), Raipur, Chhattisgarh, India
Keywords: Dural arteriovenous fistula, indirect carotid cavernous fistula, posterior drainage carotid-cavernous fistula.
Abstract
Isolated third nerve palsy with pupillary involvement is difficult to diagnose, particularly if neuroimaging studies appear normal. A posterior drainage carotid cavernous fistula (CCF) is often missed due to lack of ocular signs and orbital bruit. A 61-year-old female was admitted with a two-week history of insidious-onset, progressive drooping of the right eyelid and binocular double vision. On examination, the patient had complete ptosis of the right eyelid and right oculomotor nerve palsy. A CCF may not always present with ocular congestion; oculomotor palsy with pupillary involvement may be caused by a posterior drainage CCF, also known as a “white-eyed shunt.”
Cite this article as: Agrawal A, Sahu C, Kohat AK, Fatima A, Gupta M. Unveiling uncommon connections: Posterior drainage carotid cavernous fistula presenting as isolated oculomotor palsy. Turk J Neurol 2025;31(2):224-228. doi: 10.55697/tnd.2025.237.
The data that support the findings of this study are available from the corresponding author upon reasonable request.
All authors contributed equally to this article.
The authors declared no conflicts of interest with respect to the authorship and/or publication of this article.
The authors received no financial support for the research and/or authorship of this article.