Abstract
A 77-year-old woman was referred to our hospital by a primary care physician for further evaluation of oculomotor paralysis. We diagnosed Tolosa-Hunt syndrome and prescribed prednisolone 30 mg/day, after which her symptoms improved. Approximately 1 year after the onset of Tolosa-Hunt syndrome, she presented with abducens paralysis and ocular hyperemia, and a bruit was heard in her right orbit.
Findings from cerebral angiography indicated a diagnosis of cavernous sinus dural arteriovenous fistula. Her condition required immediate medical attention, and we thus performed endovascular coil embolization by microcatheter insertion into the right cavernous sinus via the bilateral inferior petrosal sinuses. After the procedure, the bruit disappeared and her abducens paralysis and ocular hyperemia improved. A cerebral angiogram 6 months after the procedure confirmed the disappearance of the cavernous sinus dural arteriovenous fistula. The precise cause of intracranial dural arteriovenous fistulas has not been determined, although secondary factors such as inflammation, trauma, surgery, tumors, previous infections, and sinus thrombosis have all been implicated in the past.
We hypothesize that in this instance, inflammation that remained due to inadequate prednisolone dosing induced the cavernous sinus dural arteriovenous fistula in our patient.
Correct diagnosis and adequate treatment of Tolosa-Hunt syndrome are important. In addition, the careful evaluation of patients with a history of Tolosa-Hunt syndrome may aid in diagnosing cavernous sinus dural arteriovenous fistula.
