[A case of spontaneous arteriovenous fistula presenting as the partial oculomotor nerve palsy]

We report a case of partial oculomotor nerve palsy due to spontaneous arteriovenous fistula. A 62-year-old man noticed double vision on downward gaze and periorbital pain. Clinical examination revealed inability to move the left eye downwards and to the right, and also anisocoria. No conjunctival injection or proptosis was noted. Findings of computed tomographic scan, magnetic resonance imaging and magnetic resonance angiography of the orbits, cavernous sinus region and brainstem were all normal. Carotid angiography demonstrated arteriovenous fistula via the left ophthalmic artery, the dural branch of the left external carotid artery, and the dural branch of the right internal carotid artery. Partial oculomotor palsy in this case indicated that the left inferior branch of the oculomotor nerve was affected. Inferior branch palsy of the oculomotor nerve in spontaneous arteriovenous fistula has not been described in the literature, while it is reported in cases of trauma, tumor, or aneurysm of the cavernous sinus.