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Case Reports
. 2014 Sep 26:5:140.
doi: 10.4103/2152-7806.141888. eCollection 2014.

Carotid-cavernous fistula as a mimicker of myasthenia gravis

Anastasia Eswar  1 , Howard D Pomeranz  1 , S Murthy Vishnubhakat  1 , Marissa Oller-Cramsie  1
Affiliations
Case Reports

Carotid-cavernous fistula as a mimicker of myasthenia gravis

Anastasia Eswar et al. 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.

Keywords: Carotid-cavernous fistula; fluctuating ophthalmic symptoms; myasthenia gravis; repetitive nerve stimulation; single-fiber electromyography.

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Figures

Figure 1
Figure 1
(a) Left carotid cavernous dural arteriovenous fistula draining into the left cavernous sinus (arrow) in AP digital subtraction angiography of the left carotid artery. (b) Left carotid cavernous dural arteriovenous fistula draining into the left cavernous sinus (arrow) in lateral digital subtraction angiography of the left carotid artery
Figure 2
Figure 2
(a) Arterial phase of the left internal carotid artery post embolization demonstrating complete occlusion of the left carotid cavernous dural arteriovenous fistula in AP view. (b) Arterial phase of the left internal carotid artery post embolization demonstrating complete occlusion of the left carotid cavernous dural arteriovenous fistula in lateral view
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References

    1. Albert GW, Dahdaleh NS, Hasan DM. Direct carotid-cavernous fistula presenting with minimal symptoms and rapid angiographic progression. J Clin Neurosci. 2010;17:1187–9. - PubMed
    1. Barrow DL, Spector RH, Braun IF, Landman JA, Tindall SC, Tindall GT. Classification and treatment of spontaneous carotid-cavernous sinus fistulas. J Neurosurg. 1985;62:248–56. - PubMed
    1. Engstrom JW. Seminars in neurology. 02. Vol. 24. Seventh Avenue, NewYork, NY 10001, USA: Thieme Medical Publishers, Inc; 2004. Myasthenia gravis: Diagnostic mimics; pp. 141–7. Copyright© 2004.333. - PubMed
    1. Grumann AJ, Boivin-Faure L, Chapot R, Adenis JP, Robert PY. Ophthalmologic outcome of direct and indirect carotid cavernous fistulas. Int Ophthalmol. 2012;32:153–9. - PubMed
    1. Lee KY, Kim SM, Kim DI. Isolated bilateral abducens nerve palsy due to carotid cavernous dural arteriovenous fistula. Yonsei Med J. 1998;39:283–6. - PubMed

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