Abducens nerve palsy on a patient with sphenoid fungal rhinosinusitis and cavernous sinus meningioma – Case report

Abstract We report a case of a 47-year-old patient recently diagnosed with left abducens nerve palsy, who was admitted in our clinic with diplopia. The cranio-facial CT scan revealed left sphenoid fungal rhinosinusitis and the patient underwent endoscopic surgery with complete removal of the fungal material. The immediate postoperative evolution of the patient was favourable, with partial improvement of diplopia. The first month follow-up visit revealed the recurrence of the diplopia, so the patient performed an MRI scan of the brain that showed a cavernous sinus meningioma. The patient was referred to a neurosurgeon who choose a “wait-and-see” strategy instead of surgery. The paper presents the limits of computed tomography versus magnetic resonance imaging in the radiologic diagnosis of intracranial tumors.

Download Full-text

Pitfalls in Endovascular Treatment of Dural Arteriovenous Fistulas Involving the Cavernous Sinus

Interventional Neuroradiology ◽

10.1177/15910199970030s217 ◽

1997 ◽

Vol 3 (2_suppl) ◽

pp. 88-92

Author(s):

N. Kuwayama ◽

S. Endo ◽

M. Kubo ◽

T. Akai ◽

A. Takaku

Keyword(s):

Endovascular Treatment ◽

Cavernous Sinus ◽

Nerve Palsy ◽

Transarterial Embolization ◽

Abducens Nerve ◽

Abducens Nerve Palsy ◽

Arteriovenous Fistulas ◽

Type D ◽

Dural Arteriovenous Fistulas ◽

The Right

Angiographic changes of the sylvian veins, superior ophthalmic vein (SOV), and superior petrosal sinus (SPS) before and after endovascular treatment were determined for 18 patients with dural arteriovenous fistulas (AVFs) involving the cavernous sinus, and pitfalls of endovascular treatment, especially regarding venous drainage routes, for 3 of the patients were reported. Case 1: 57-year-old woman who presented with right abducens nerve palsy had a Barrow type D fistula in the right cavernous sinus draining into the bilateral inferior petrosal sinuses (IPS). One of the ipsilateral sylvian veins that had drained antegradely before treatment was occluded, and a small lacunar infarction in the corona radiata developed after transvenous embolization (TVE) of the right cavernous sinus. Case 2: 72-year-old woman who presented with symptoms of right ocular hypertension had a type D fistula in the right cavernous sinus draining into only the ipsilateral SOV. Conjunctival hyperemia persisted and was aggravated after angioanatomical obliteration of the fistula by transarterial embolization. Case 3: 55-year-old man who presented with left abducens nerve palsy had a type D fistula in the left cavernous sinus draining into the ipsilateral IPS and sylvian vein. The dural AVF was obliterated once with TVE, but recurred 1 week later with retrograde drainage into the ipsilateral SPS and mesencephalic veins. A second TVE resulted in complete obliteration of the fistula. In conclusion, detailed analysis of drainage routes is necessary for planning of treatment of patients with dural AVF, and prompt treatment is needed when redistribution of drainage routes develops during or after TVE.

Download Full-text

Delayed abducens nerve palsy after transvenous coil embolization for cavernous sinus dural arteriovenous fistulae

Acta Neurochirurgica ◽

10.1007/s00701-013-1926-3 ◽

2013 ◽

Vol 156 (1) ◽

pp. 97-101 ◽

Cited By ~ 15

Author(s):

Daina Kashiwazaki ◽

Naoya Kuwayama ◽

Naoki Akioka ◽

Satoshi Kuroda

Keyword(s):

Cavernous Sinus ◽

Coil Embolization ◽

Nerve Palsy ◽

Abducens Nerve ◽

Abducens Nerve Palsy ◽

Arteriovenous Fistulae

Download Full-text

Severe unilateral abducens nerve palsy from cavernous sinus carotid vascular ectasia

American Journal of Ophthalmology Case Reports ◽

10.1016/j.ajoc.2018.04.006 ◽

2018 ◽

Vol 10 ◽

pp. 285-287

Author(s):

Sumeet Gupta ◽

Brian Ellis ◽

Alison Hixenbaugh ◽

Dean Bonsall

Keyword(s):

Cavernous Sinus ◽

Nerve Palsy ◽

Abducens Nerve ◽

Abducens Nerve Palsy ◽

Vascular Ectasia

Download Full-text

Dermoid cyst of the lateral wall of the cavernous sinus presenting with isolated abducens nerve palsy

Acta Neurochirurgica ◽

10.1007/s00701-013-1651-y ◽

2013 ◽

Vol 155 (4) ◽

pp. 741-742 ◽

Cited By ~ 2

Author(s):

Paolo Perrini ◽

Paolo Di Russo ◽

Aldo Iannelli

Keyword(s):

Dermoid Cyst ◽

Cavernous Sinus ◽

Nerve Palsy ◽

Abducens Nerve ◽

Lateral Wall ◽

Abducens Nerve Palsy

Download Full-text

Extracranial arteriovenous malformation and subsequent contralateral cavernous sinus dural arteriovenous fistula showing abducens nerve palsy: illustrative case

Journal of Neurosurgery: Case Lessons ◽

10.3171/case21265 ◽

2021 ◽

Vol 2 (6) ◽

Author(s):

Atsushi Tsukada ◽

Kiyoyuki Yanaka ◽

Kazuhiro Nakamura ◽

Nobuyuki Takahashi ◽

Kuniyuki Onuma ◽

...

Keyword(s):

Arteriovenous Fistula ◽

Cavernous Sinus ◽

Nerve Palsy ◽

Spontaneous Regression ◽

Dural Arteriovenous Fistula ◽

Abducens Nerve ◽

Abducens Nerve Palsy ◽

Illustrative Case ◽

Vascular Structure ◽

The Right

BACKGROUND Extracranial arteriovenous malformations (AVMs) are rare clinical entities and on rare occasions cause neurological symptoms. The authors report a case of an extracranial pterygoid AVM and a subsequent contralateral cavernous sinus dural arteriovenous fistula (dAVF) presenting with abducens nerve palsy. OBSERVATIONS An 80-year-old woman was referred to the authors’ hospital with left abducens nerve palsy followed by right ophthalmalgia. Magnetic resonance imaging (MRI) showed abnormal vessel staining in the left pterygoid and the right inferior petrosal sinus (IPS). Cerebral angiography revealed a left pterygoid AVM draining into the right IPS via the cavernous sinus (CS). A dAVF in the right CS was also revealed. The right ophthalmalgia disappeared spontaneously, and, 4 months later, the left abducens nerve palsy also disappeared after conservative management. Follow-up MRI showed spontaneous regression of the AVM and dAVF. The disappearance of the dAVF was considered to be due to spontaneous regression of the left pterygoid AVM and the consequent decrease in venous pressure of the CS, and the symptoms eventually disappeared. LESSONS The authors treated an extremely rare case of extracranial AVM with dramatic changes in vascular structure and symptoms. Understanding of the pathophysiology between symptoms and dynamic changes in the vascular structure is essential for providing the appropriate treatment.

Download Full-text