{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,22]],"date-time":"2025-11-22T11:09:13Z","timestamp":1763809753398,"version":"3.44.0"},"reference-count":7,"publisher":"BMJ","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Reports"],"accepted":{"date-parts":[[2017,9,23]]},"abstract":"<jats:p>71-year-old woman with progressive left-sided, monocular diplopia and ptosis. Her symptoms mimicked ocular myasthenia, but she had an indirect carotid cavernous fistula (CCF). She was diagnosed with monocular myasthenia gravis (negative acetylcholinesterase antibody) after a positive ice test and started on Mestinon and underwent a thymectomy complicated by a brachial plexus injury. Months later, she developed left-sided proptosis and ocular bruit. She was urgently referred to neuro-interventional surgery and was diagnosed with an indirect high-flow left CCF, which was treated with Onyx liquid and platinum coil embolisation. Mestinon was discontinued. Her ophthalmic symptoms resolved. However, she was left with a residual left arm and hand hemiparesis and dysmetria secondary to a brachial plexus injury. Indirect CCF usually can present with subtle and progressive symptoms leading to delayed diagnosis or misdiagnosis. It is important for ophthalmologists to consider this differential in a patient with progressive ocular symptoms.<\/jats:p>","DOI":"10.1136\/bcr-2017-222048","type":"journal-article","created":{"date-parts":[[2017,10,20]],"date-time":"2017-10-20T00:15:27Z","timestamp":1508458527000},"page":"bcr-2017-222048","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":3,"title":["Indirect carotid cavernous fistula mimicking ocular myasthenia"],"prefix":"10.1136","volume":"2017","author":[{"given":"Lakshmi","family":"Leishangthem","sequence":"first","affiliation":[{"name":"Department of Neurology, Albert Einstein Medical Center, Philadelphia, Pennsylvania, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sudhakar Reddy","family":"Satti","sequence":"additional","affiliation":[{"name":"Department of Neurointerventional Surgery, Christiana Care Health Center, Newark, Delaware, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2017,10,19]]},"reference":[{"key":"2025082801504360000_2017.oct16_1.bcr-2017-222048.1","doi-asserted-by":"publisher","DOI":"10.3171\/jns.1985.62.2.0248"},{"key":"2025082801504360000_2017.oct16_1.bcr-2017-222048.2","doi-asserted-by":"crossref","first-page":"83","DOI":"10.1053\/scds.2001.24080","article-title":"Carotid cavernous fistula","volume":"1","author":"Tytle","year":"2001","journal-title":"Seminars in Cerebrovascular Diseases and Stroke"},{"key":"2025082801504360000_2017.oct16_1.bcr-2017-222048.3","doi-asserted-by":"crossref","first-page":"143","DOI":"10.4329\/wjr.v5.i4.143","article-title":"Endovascular treatment of carotid cavernous sinus fistula: A systematic review","volume":"5","author":"Korkmazer","year":"2013","journal-title":"World J Radiol"},{"key":"2025082801504360000_2017.oct16_1.bcr-2017-222048.4","first-page":"1","article-title":"Indirect cavernous carotid fistula in a 12-year-old girl","volume":"6","author":"Livi","year":"20162016","journal-title":"J Surg Case Rep"},{"key":"2025082801504360000_2017.oct16_1.bcr-2017-222048.5","doi-asserted-by":"crossref","first-page":"283","DOI":"10.3349\/ymj.1998.39.3.283","article-title":"Isolated bilateral abducens nerve palsy due to carotid cavernous dural arteriovenous fistula","volume":"39","author":"Lee","year":"1998","journal-title":"Yonsei Med J"},{"key":"2025082801504360000_2017.oct16_1.bcr-2017-222048.6","doi-asserted-by":"crossref","first-page":"153","DOI":"10.1007\/s10792-012-9550-4","article-title":"Ophthalmologic outcome of direct and indirect carotid cavernous fistulas","volume":"32","author":"Grumann","year":"2012","journal-title":"Int Ophthalmol"},{"key":"2025082801504360000_2017.oct16_1.bcr-2017-222048.7","doi-asserted-by":"publisher","DOI":"10.2214\/ajr.149.3.587"}],"container-title":["BMJ Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bcr-2017-222048","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,28]],"date-time":"2025-08-28T08:50:47Z","timestamp":1756371047000},"score":1,"resource":{"primary":{"URL":"https:\/\/casereports.bmj.com\/lookup\/doi\/10.1136\/bcr-2017-222048"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2017,10,19]]},"references-count":7,"alternative-id":["10.1136\/bcr-2017-222048"],"URL":"https:\/\/doi.org\/10.1136\/bcr-2017-222048","relation":{},"ISSN":["1757-790X"],"issn-type":[{"type":"electronic","value":"1757-790X"}],"subject":[],"published":{"date-parts":[[2017,10,19]]}}}