Bilateral sixth-nerve palsy associated with dural arteriovenous malformation

A fifty-two year old postmenopausal woman was admitted to the hospital with complaints of diplopia, headache, humming over the head, and pain over the left eye. Neurological examination showed right abducens nerve palsy. In a few days, she also developed left abducens nerve palsy and chemosis, exophthalmos, and proptosis of both eyes. There was pulsation over the left eye. Intraocular pressure was found to be elevated bilaterally. Selective carotid angiograms showed the presence of bilateral dural arteriovenous malformations (AVM) supplied by the external carotid arteries. Two months after the embolisation of the AVMs, eye movements improved. Repeat angiograms showed the absence of flow into the previously embolised AVMs.