J Korean Ophthalmol Soc > Volume 57(6); 2016 > Article
Journal of the Korean Ophthalmological Society 2016;57(6):977-982.
DOI: https://doi.org/10.3341/jkos.2016.57.6.977    Published online June 15, 2016.
A Case of Cavernous Sinus Dural Arteriovenous Fistula Following Tolosa-Hunt Syndrome.
Aram Park, Seung Woo Kim, Seung Ah Chung
Department of Ophthalmology, Ajou University School of Medicine, Suwon, Korea. mingming8@naver.com
톨로사-헌트 증후군에서 속발한 경막동맥해면정맥굴샛길 1예
박아람⋅김승우⋅정승아
아주대학교 의과대학 안과학교실
Correspondence:  Seung Ah Chung,
Email: mingming8@naver.com
Received: 29 October 2015   • Revised: 19 January 2016   • Accepted: 25 January 2016
Abstract
PURPOSE
To report a case of cavernous sinus dural arteriovenous fistula following Tolosa-Hunt syndrome. CASE SUMMARY: A 64-year-old female with a history of hypertension, presented with blepharoptosis and periorbital pain in the right eye and diplopia. Her right pupil was dilated. She had right exotropia and right hypertropia with inability to elevate, depress, and adduct the right eye. Magnetic resonance imaging including angiography, revealed hyperintensities in the right cavernous sinus consistent with inflammation and no vascular abnormalities. Three days after oral corticosteroid therapy, the pain disappeared. A presumptive diagnosis was Tolosa-Hunt syndrome presenting as a form of complete oculomotor nerve palsy. Two months later, she experienced severe pain in the right periocular area, even though blepharoptosis was resolved and ocular motility was improved. A rapid response to high-dose intravenous corticosteroids was consistent with recurrence of Tolosa-Hunt syndrome. Three months later, she had normal ocular motility, but developed a conjunctival injection, pulsatile orbital bruits, and exophthalmos in the right eye. Cerebral angiography showed a cavernous sinus dural arteriovenous fistula. She received a transvenous coil embolization and her symptoms markedly improved over 2 months. CONCLUSIONS: Tolosa-Hunt syndrome, a granulomatous inflammation in the cavernous sinus may be followed by cavernous sinus dural arteriovenous fistula and should be considered during follow-up.
Key Words: Cavernous sinus;Dural arteriovenous fistula;Tolosa-Hunt syndrome


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