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Delayed Onset Abducens Nerve Palsy and Horner Syndrome after Treatment of a Traumatic Carotid-cavernous Fistula
외상목동맥해면굴샛길의 색전술 후 지연 발생한 한 눈 가돌림신경마비와 호너증후군
JKOS 2019 Sep;60(9):905-8
Published online September 15, 2019;
Copyright © 2019 The Korean Ophthalmological Society.
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Won Jae Kim, MD, Cheol Won Moon, MD, Myung Mi Kim, MD, PhD
김원제 · 문철원 · 김명미

Department of Ophthalmology, Yeungnam University College of Medicine, Daegu, Korea
영남대학교 의과대학 안과학교실
Received February 12, 2019; Revised March 12, 2019; Accepted August 16, 2019.
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Purpose: We report a patient with delayed-onset abducens nerve palsy and Horner syndrome after endovascular treatment of traumatic carotid-cavernous fistula (CCF).
Case summary: A 68-year-female visited our ophthalmic department complaining of gradual-onset ptosis of the left eye and horizontal diplopia. She had undergone endovascular treatment to treat left-sided traumatic CCF after a car accident 10 years before; she had been told at that time that the treatment outcome was favorable. The left-sided ptosis gradually developed 6 years after the procedure, accompanied by diplopia. The left eye exhibited miosis and the extent of anisocoria increased in dim light. An extraocular examination revealed 30 prism diopters of left esotropia in the primary gaze and a -4 abduction limitation of the left eye. CCF recurrence was suspected; however, magnetic resonance imaging with magnetic resonance angiography of brain did not support this. The esotropia did not improve during the 6-month follow-up and strabismus surgery was performed.
Conclusions: Delayed-onset abducens nerve palsy and Horner syndrome can develop even after successful endovascular treatment of CCF. Strabismus surgery should be considered in patients whose diplopia does not spontaneously improve.
Keywords : Abducens nerve diseases, Carotid-cavernous sinus fistula, Horner syndrome


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