High-flow carotid cavernous fistula and 'white eye': A rare and easily misdiagnosed presentation - A case report and literature review

J R Coll Physicians Edinb. 2024 Jun;54(2):144-148. doi: 10.1177/14782715241246572. Epub 2024 Apr 18.

Abstract

The three classic symptoms of carotid cavernous fistula (CCF) are pulsating exophthalmos, bruit and conjunctival chemosis. Here, we present a clinical case of isolated abducens nerve palsy due to a high-flow CCF in an 84-year-old woman, without the typical congestive orbito-ocular features. It was a diagnostic challenge because, for patients older than 50 years with cardiovascular risk factors, ischaemic mononeuropathy is the most frequent aetiology. This case illustrates the least common type of CCF that can be easily misdiagnosed. Physicians should consider fistula as a possible diagnosis in a patient with isolated abducens nerve palsy even without the classic triad.

Keywords: abducens nerve palsy; carotid-cavernous fistula; diplopia; therapeutic embolisation; vascular fistula.

Publication types

  • Case Reports
  • Review

MeSH terms

  • Abducens Nerve Diseases* / diagnosis
  • Abducens Nerve Diseases* / etiology
  • Aged, 80 and over
  • Carotid-Cavernous Sinus Fistula* / diagnosis
  • Diagnostic Errors*
  • Female
  • Humans