PMC3984061_01
Three-dimensional reconstructed view of the CT angiogram.. Notes: Three-dimensional reconstructed view of the CT angiogram displaying the left internal carotid artery (red arrow) (A), followed by a two-dimensional perspective displaying 39% stenosis of the intracavernous portion of the internal carotid artery (red arrow) (B). (C) Three-dimensional view displaying the internal carotid artery at the level of the Circle of Willis: 1 internal carotid artery, 2 ophthalmic artery, 3 anterior cerebral artery, 4 optic nerve, 5 anterior lobe of pituitary gland, 6 posterior cerebral artery.. Abbreviation: CT, computed tomography.
opth-8-707Fig1.jpg
PMC3984061_01_opth-8-707Fig1.jpg
f1-opth-8-707
Computed tomography (CT) scans of the brain without contrast were performed during both visits, with neither showing any acute intracranial abnormalities. CT angiogram (CTA) showed no signs of a dissecting ICA or mass in the superior stellate ganglion of the neck, but it revealed 39% stenosis of the left ICA at the intracavernous portion (Figure 1).
Complete ptosis and ophthalmoplegia in the left eye.
opth-8-707Fig2.jpg
PMC3984061_01_opth-8-707Fig2.jpg
f2-opth-8-707
Ophthalmologic evaluation disclosed complete ptosis and ophthalmoplegia in the left eye, with the eye in central position (Figure 2).
T1 and T2-weighted MRI with gadolinium contrast of the brain and orbits.. Notes: Coronal T2-weighted MRI disclosing a 5x9x10 mm abnormal enhancing of the soft tissue in the left superior orbital fissure with mild extension along the anterior aspect of the left cavernous sinus (red arrow) (A), and an axial T1-weighted MRI disclosing mild edema of the left lateral rectus (red arrow) (B).. Abbreviations: MRI, magnetic resonance imaging. T1, spin-lattice relaxation time; T2, spin-spin relaxation time.
opth-8-707Fig3.jpg
PMC3984061_01_opth-8-707Fig3.jpg
f3-opth-8-707
A subsequent MRI performed 3 days after the initial MRI disclosed a lesion in the left superior orbital fissure with mild extension along the anterior aspect of the left cavernous sinus (Figure 3A), and mild edema of the lateral rectus (Figure 3B).