Incomplete Third Nerve Palsy Due to a Carotid-Cavernous Fistula

Area of Science:

• Neuroscience
• Ophthalmology
• Vascular Surgery

Background:

• Oculomotor nerve palsies necessitate excluding various lesions, including dural arteriovenous fistulae like carotid-cavernous fistulae (CCF).
• CCF can present atypically, potentially delaying diagnosis despite being a treatable cause of third nerve palsy.

Approach:

• A case report details a 63-year-old female with gradual horizontal diplopia and partial left oculomotor nerve palsy.
• Cerebral angiography identified an indirect left CCF supplied by the internal carotid artery.
• Transvenous embolization was successfully performed.

Key Points:

• The patient presented with isolated third nerve palsy without typical congestive eye symptoms.
• Diagnosis of CCF was confirmed via cerebral angiography.
• Successful transvenous embolization led to complete recovery.

Conclusions:

• This case illustrates a CCF with posterior drainage, presenting as isolated third nerve palsy.
• The varied presentations of CCF warrant clinical awareness for timely diagnosis.
• Successful interventional management of CCF offers a favorable outcome.