Afferent pupillary defect and dilated episcleral and conjunctival vessels in a patient with arteriovenous malformation of the brain.

A 42-year-old man had unilateral Marcus Gunn pupil and bilaterally dilated episcleral vessels. After several weeks of testing, using computed tomographic (CT) scanning and angiography, the diagnosis of arteriovenous malformation (AVM) of the brain was made. Except for the partial optic atrophy in the left eye, fundi were normal, with few of the neurologic and systemic manifestations reported previously. To my knowledge, this is the first documented case of an AVM of the brain with no evidence of an arteriovenous shunt, but with an afferent pupillary defect instead.