Delayed Onset Cranial Nerve Palsies After Endovascular Coil Embolization of Direct Carotid-Cavernous Fistulas

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Title Delayed Onset Cranial Nerve Palsies After Endovascular Coil Embolization of Direct Carotid-Cavernous Fistulas
Creator Alaa Bou Ghannam, MD, Prem S. Subramanian, MD, PhD
Affiliation Departments of Ophthalmology, Neurology, and Neurosurgery (ABG, PSS), University of Colorado School of Medicine, Aurora, Colorado
Abstract Late recurrence of visual symptoms associated with carotid-cavernous fistula (CCF), including diplopia, is uncommon and raises concern for new or recurrent fistula formation. We report 2 patients with traumatic CCFs, where cranial nerve paresis resolved after endovascular CCF treatment only to reappear years later. No evidence of recurrent or new fistula formation was found. Both were treated successfully with strabismus surgery. Although the cause of delayed onset diplopia after successful treatment is still unknown, theories include late compression of cranial nerves within the cavernous sinus due to coil mass that can cause chronic ischemia, delayed inflammation due to a thrombophilic nidus created by the coil mass, or injury to the cranial nerves that manifests later due to decompensated strabismus.
Subject Abducens Nerve Diseases; Accidents, Traffic; Adult; Carotid-Cavernous Sinus Fistula; Cerebral Angiography; Diplopia; Embolization, Therapeutic; Endovascular Procedures; Eye Movements; Humans; Male; Oculomotor Muscles; Oculomotor Nerve Diseases; Ophthalmologic Surgical Procedures; Recurrence; Young Adult
OCR Text Show
Date 2018-06
Language eng
Format application/pdf
Type Text
Publication Type Journal Article
Source Journal of Neuro-Ophthalmology, June 2018, Volume 38, Issue 2
Publisher Lippincott, Williams & Wilkins
Holding Institution Spencer S. Eccles Health Sciences Library, University of Utah, 10 N 1900 E SLC, UT 84112-5890
Rights Management © North American Neuro-Ophthalmology Society
ARK ark:/87278/s6bc8jrx
Setname ehsl_novel_jno
ID 1452560
Reference URL https://collections.lib.utah.edu/ark:/87278/s6bc8jrx
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