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. Although these fistulas tend to regress spontaneously, permanent neurological deficits are observed in as many as 20-30% of untreated patients. 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 orbit, periorbital veins, and oculomotor, trochlear, and abducens nerve palsy. In addition, facial palsy and nystagmus are rarely seen as clinical manifestations of dural carotid cavernous fistulas, but can arise as complex consequences of embolization.