Facial Palsy and Nystagmus after Transvenous Embolization of a Carotid Cavernous Fistula

Intracranial dural carotid cavernous fistulas account for 10 to 15 % of all intracranial arteriovenous malformations.1 Although these fistulas tend to regress spontaneously, permanent neuro-logical deficits are observed in as many as 20-30 % of untreated patients.2,3 In general, transvenous or transarterial embolization of the fistula is a safe and successful treatment option. Depending on the amount and direction of venous drainage from the cavernous sinus, symptoms may include distended or-bit, periorbital veins, and oculomotor, trochlear, and abducens nerve palsy.2,3 In addition, facial palsy and nystagmus are rarely seen as clinical manifestations of dural carotid cavernous fistu-las,4 but can arise as complex consequences of embolization. A 41-year-old female visited our clinic with headache and vertical diplopia. The headache was pulsatile, located in the right orbito-temporal region, and had persisted for a month