Publication Date

2014

Journal Title

Surg Neurol Int

Abstract

BACKGROUND: A carotid-cavernous fistula (CCF) is an abnormal communication between the carotid arterial system and the cavernous sinus. Common symptoms of CCFs include proptosis and ophthalmoplegia, but fluctuating diplopia and presence of ptosis are not typical. CASE DESCRIPTION: We present an unusual case of CCF with fluctuating binocular diplopia and ptosis, mimicking myasthenia gravis. Electrodiagnostic testing, which included repetitive nerve stimulation and single-fiber electromyography, was normal. Magnetic resonance imaging of the brain and orbits was initially normal, but later magnetic resonance angiography revealed enlargement of the left superior ophthalmic vein along with a left CCF. Patient underwent a successful left cavernous sinus embolization. CONCLUSION: Fluctuating ophthalmic symptoms are a typical presentation of myasthenia gravis; however, there may be an association of these symptoms with a CCF. Repetitive nerve stimulation and single-fiber electromyography played a key role in diagnosis of this case, as the normal result led to further investigations revealing a CCF.

Volume Number

5

Pages

140

Document Type

Article

EPub Date

2014/10/16

Status

Faculty; Northwell Researcher

Facility

School of Medicine; Northwell Health

Primary Department

Ophthalmology

Additional Departments

Neurology

PMID

25317355

DOI

10.4103/2152-7806.141888


Included in

Neurology Commons

Share

COinS