Patient with painful ophthalmoplegia after traffic accidents

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Presentation transcript:

Patient with painful ophthalmoplegia after traffic accidents Teaching NeuroImages Neurology Resident and Fellow Section © 2014 American Academy of Neurology

Vignette A 57 year-old man with a traffic accident 1 month ago presented with left ocular pain and double vision. Neurological examination revealed that complete external ophthalmoplegia, exophthalmos and conjunctival hemorrhage. Choi, et al. © 2014 American Academy of Neurology

Figure 1. Clinical presentations Imaging Figure 1. Clinical presentations Figure 1. (A) Left eye with conjunctival injection and ptosis. (B) Protruded left eye. (C) Fundus showed dilated veins with no hemorrhages or disc edema. (D) The ocular motility showed complete external ophthalmoplegia in left eye and partial limitation of abduction in right eye. Choi, et al. © 2014 American Academy of Neurology

Imaging Choi, et al. Figure 2. Brain imaging Figure 2. Contrast-enhanced MRI (A) and MRA (B) showed a dilated left superior ophthalmic vein (black arrowhead) and a extravasation into cavernous sinus (white arrow) Choi, et al. © 2014 American Academy of Neurology

Audio Audio. Left orbital auscultation revealed a high-pitched orbital bruit. Choi, et al. © 2014 American Academy of Neurology

Ocular Bruit in CCF With chemosis, ophthalmoplegia and retro-orbital pain, the auscultation of orbital bruit can make a correct and prompt diagnosis in the patient with carotid-cavernous sinus fistula (CCF). REFERENCES 1. Ling JD, Chao D, Al Zubidi N, Lee AG. Big red flags in neuro-ophthalmology. Can J Ophthalmol. 2013;48:3-7 Choi, et al. © 2014 American Academy of Neurology