Carotid-Cavernous Fistula Presenting as Isolated Painful Anisocoria

ABSTRACT

A painful isolated third nerve palsy is an uncommon presenting sign of a carotid-cavernous fistula (CCF). It mostly occurs in dural CCFs with posterior drainage into the petrosal sinuses. We present a case of a 50-year-old woman who developed acute right periorbital facial pain in the territory of the first branch of the right trigeminal nerve and was noted to have a right dilated unreactive pupil with very subtle right ptosis. She was subsequently diagnosed with a posteriorly draining dural CCF.

KEYWORDS:

• Carotid-cavernous fistula
• third nerve palsy
• anisocoria
• facial pain

Disclosure statement

No potential conflict of interest was reported by the authors.

Additional information

Funding

This work was supported in part by a departmental grant (Department of Ophthalmology) from Research to Prevent Blindness, Inc., New York, and by Core Grant P30-EY06360 (Department of Ophthalmology) from the National Institutes of Health, Bethesda, MD.