Unveiling uncommon connections: Posterior drainage carotid cavernous fistula presenting as isolated oculomotor palsy

Arpit Agrawal; Chandradev Sahu; Abhijeet Kumar Kohat; Anam Fatima; Manisha Gupta

doi:10.55697/tnd.2025.237

Arpit Agrawal¹, Chandradev Sahu², Abhijeet Kumar Kohat¹, Anam Fatima², Manisha Gupta¹

¹Department of Neurology, DKSPGI (Dau Kalyan Singh Postgraduate Institute), Raipur, Chhattisgarh, India
²Department of Radiology, PTJNMMC (Pandit Jawahar Lal Nehru Medical College), Raipur, Chhattisgarh, India

Keywords: Dural arteriovenous fistula, indirect carotid cavernous fistula, posterior drainage carotid-cavernous fistula.

Abstract

Isolated third nerve palsy with pupillary involvement is difficult to diagnose, particularly if neuroimaging studies appear normal. A posterior drainage carotid cavernous fistula (CCF) is often missed due to lack of ocular signs and orbital bruit. A 61-year-old female was admitted with a two-week history of insidious-onset, progressive drooping of the right eyelid and binocular double vision. On examination, the patient had complete ptosis of the right eyelid and right oculomotor nerve palsy. A CCF may not always present with ocular congestion; oculomotor palsy with pupillary involvement may be caused by a posterior drainage CCF, also known as a “white-eyed shunt.”

Cite this article as: Agrawal A, Sahu C, Kohat AK, Fatima A, Gupta M. Unveiling uncommon connections: Posterior drainage carotid cavernous fistula presenting as isolated oculomotor palsy. Turk J Neurol 2025;31(2):224-228. doi: 10.55697/tnd.2025.237.