A Case of Isolated Third Nerve Palsy with Pupillary Involvement Diagnosed with Cavernous Dural Arteriovenous Fistula
Yeo Jung Kim, MD, Suk Yoon Lee, MD, Jin-ho Jung, MD, Jung Hwa Seo, MD, Eung-Gyu Kim, MD, PhD, Ki-Hwan Ji, MD, Jong Seok Bae, MD, and Sang-Jin Kim, MD
Department of Neurology, Inje University College of Medicine, Busan Paik Hospital, Busan, Korea
ABSTRACT
Background: Third nerve palsy can result from lesions located anywhere along its path from the oculomotor nucleus to the nerve termination within the extraocular muscles of the orbit. Common etiologies of isolated third nerve palsy with pupil involvement are intracranial aneurysm, uncal herniation, neoplasia, and traumatic and inflammatory conditions. Case Report: We present a case of a 71-year-old female with complete left third nerve palsy with pupillary involvement. She was diagnosed with cavernous dural arteriovenous fistula (dAVF) using source images of time-of-flight (TOF) magnetic resonance (MR). Cerebral angiography revealed a cavernous dAVF via a branch of the distal intracranial artery. Conclusions: Isolated third nerve palsy may be caused by cavernous dAVF, and TOF MR angiography may be a useful non-invasive pre-diagnostic tool for detecting the shunts.
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