ARPİT AGRAWAL, CHANDRADEV SAHU, ABHİJEET KUMAR KOHAT, ANAM FATİMA, MANİSHA GUPTA
Turkish Journal of Neurology - 2025;31(2):224-228
Isolated third nerve palsy with pupillary involvement is difficult to diagnose, particularly if neuroimaging studies appear normal. A posterior drainage carotid cavernous fistula (CCF) is often missed due to lack of ocular signs and orbital bruit. A 61-year-old female was admitted with a two-week history of insidious-onset, progressive drooping of the right eyelid and binocular double vision. On examination, the patient had complete ptosis of the right eyelid and right oculomotor nerve palsy. A CCF may not always present with ocular congestion; oculomotor palsy with pupillary involvement may be caused by a posterior drainage CCF, also known as a white-eyed shunt.
