title: Traumatic carotid-cavernous sinus fistula accompanying abducens nerve (VI) palsy in blowout fractures: missed diagnosis of 'white-eyed shunt'.
abstract: We report the case of a 32-year-old woman with bilateral blowout fractures. She presented with diplopia showing impaired abduction of the left eye soon after trauma. No other orbito-ocular signs, such as exophthalmos, ptosis, or chemosis, were found. Orbital reconstruction was performed, but no improvement in her ophthalmoplegia was observed after surgery. A carotid angiography showed that she was suffering from a posteriorly draining carotid-cavernous sinus fistula with isolated abducens nerve palsy. Coil embolization was conducted under the consultation of a neurosurgeon, after which her ophthalmoplegia resolved fully. This is a rare case of posteriorly draining carotid-cavernous sinus fistula without classic orbito-ocular signs, the absence of which may cause diagnostic confusion.
authors: Department of Oral and Maxillofacial Surgery, Ewha Womans University, Seoul, Republic of Korea.
authors: Jin-Woo
authors: JW
authors: Kim
authors: Sun-Jong
authors: SJ
authors: Kim
authors: Myung-Rae
authors: MR
authors: Kim
mesh_terms: D000010:Abducens Nerve / Q000000981:diagnostic imaging*; D020434:Abducens Nerve Diseases / Q000209:etiology*; D000328:Adult; D020216:Carotid-Cavernous Sinus Fistula / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D002426:Cavernous Sinus / Q000000981:diagnostic imaging; D004621:Embolization, Therapeutic / Q000379:methods; D005260:Female; D006801:Humans; D021621:Imaging, Three-Dimensional; D009886:Ophthalmoplegia / Q000209:etiology; D009915:Orbit / Q000000981:diagnostic imaging; D009917:Orbital Fractures / Q000150:complications* / Q000000981:diagnostic imaging; D011859:Radiography