통증을 동반한 외전마비로 나타난 경막동맥해면정맥동루 1예

Cavernous Sinus Dural Arteriovenous Fistula Presenting as Painful Isolated Abducens Nerve Palsy

Purpose: To report a case of cavernous sinus dural arteriovenous fistula who presented with painful isolated abducens nerve palsy along with the characteristic conjunctival features. Case summary: A 71-year-old female was referred to our clinic due to left eye pain and binocular diplopia. Esodeviation of 20 prism diopters was found with abduction limitation in the left eye. Slit lamp examination showed conjunctival injection, edema and corkscrew vessel dilatation in the left eye. Brain magnetic resonance angiography showed rapid filling and increased blood flow in the left superior ophthalmic vein and cavernous sinus. Cerebral angiography revealed direct venous drainage from the left cavernous sinus fistula into the left superior ophthalmic vein. After coil embolization, the left eye showed improvement in pain, conjunctival congestion and abduction limitation. Conclusions: Cavernous sinus dural arteriovenous fistula should be considered when characteristic symptoms and conjunctival signs are accompanied with painful isolated abducens nerve palsy.