Cranial nerve palsies in spontaneous carotid artery dissection.

Sturzenegger, Matthias; Huber, Philipp

doi:10.1136/jnnp.56.11.1191

Cited by 128 publications

(87 citation statements)

References 32 publications

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“…palsy has been rarely described in ICA dissection. 9,10 In contrast, bilateral seventh nerve palsy has never before been reported in ICA dissections. According to Lasjaunias and Berenstein, 11 the facial nerve is usually supplied by the vertebrobasilar system from the brain stem to the geniculate ganglion and by branches from the external carotid (middle meningeal, stylomastoid) distally, but occasionally the facial nerve is supplied by branches originating from the intracavernous carotid artery.…”

Section: Discussionmentioning

confidence: 97%

Facial Diplegia Complicating a Bilateral Internal Carotid Artery Dissection

Gout

Bonnaud

Weill

et al. 1999

Stroke

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Background and Purpose-We report a case of facial diplegia complicating a bilateral internal carotid artery dissection. Case Description-A 49-year-old patient presented with unilateral headache and oculosympathetic paresis. Cerebral angiography revealed a bilateral internal carotid artery dissection. A few days later, the patient developed a facial diplegia that regressed after arterial recanalization. An arterial anatomic variation may explain this ischemic complication of carotid dissection. Conclusions-Double carotid dissection should be included among the causes of bilateral seventh nerve palsy. (Stroke.1999;30:681-686.)Key Words: carotid artery dissection Ⅲ cerebral blood flow Ⅲ facial paralysis C ommon clinical presentation and possible ischemic complications of internal carotid artery (ICA) dissections vary. Cranial nerve palsies seem to occur in this pathological condition, appearing in Ͼ10% of the cases. 1 Several cranial nerve palsies have been described, 1,2 especially lower cranial nerves syndromes and ocular motor nerves syndromes, probably owing to transient impairment of the cranial nerves' blood supply. We describe the first reported case of facial diplegia resulting from a bilateral ICA dissection. Anatomic variation of the blood supply of the seventh cranial nerve may explain this finding. Case ReportA 49-year-old right-handed-man was referred for a left hemicrania associated with a left ptosis. His past medical history was significant for resolved poliomyelitis, a thoracic zoster eruption, and a schwannoma of the right pneumogastric nerve. He had experienced right-sided tinnitus for the past 2 years.Five days before admission, while he was on holiday, without having participated in any unusual sports activity, he experienced a left periorbital pain followed by left hemicrania and neck pain, which persisted up to his admission and fluctuated in intensity. He noticed a left ptosis 2 days later. At admission, he had left hemicrania, neck pain, and left oculosympathetic paresis. His blood pressure was 130/80 mm Hg, and the remainder of the clinical examination was normal. The erythrocyte sedimentation rate was 25 mm/h, without dysglobulinemia or nuclear antibodies. Other routine laboratory investigations and extensive coagulation studies were normal. There were neither clinical nor histological signs of a specific elastictissue disease. Brain MRI and MR angiography demonstrated bilateral dissection of the ICA, with more severe narrowing of the left ICA (Figure 1). Intravenous heparin sodium was initiated. Cerebral angiography, performed 2 days later, with selective catheterization of carotid and vertebral arteries, confirmed extensive dissection of both ICAs (Figures 2A and 2B). Both ICA territories were partially filled by the posterior circulation through the posterior communicating arteries ( Figure 2C). There was no vascular abnormality to suggest a fibromuscular dysplasia, and renal arteries were normal. Eight days after admission, a neck ultrasound examination and transcranial Doppler (TCD) ...

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Section: Discussionmentioning

confidence: 97%

Facial Diplegia Complicating a Bilateral Internal Carotid Artery Dissection

Gout

Bonnaud

Weill

et al. 1999

Stroke

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“…In der Literatur konnten wir bis anhin erst 13 angiographisch gesicherte dissektionsbedingte Fälle eines Collet-Sicard-Syndroms eruieren [9][10][11]. Die Paresen dieser Nerven, die auf Höhe und knapp unterhalb des Foramen jugulare in unmittelbarer Nähe zur ACI verlaufen, kommen dissektionsbedingt entweder wegen direkter Kompression durch die ausgeweitete ACI oder eine periadventitielle Sequestration des intramuralen Hämatoms zustande.Andererseits könnte indirekt der hämatomverursachte Druck auf die Vasa nervorum eine ischämische Neuropathie bewirken [11]. Es ist das Verdienst dieser Publikation, erstmals auf den möglicherweise unterschiedlichen Pathomechanismus der peripheren Nervenläsio-nen im Gegensatz zu den zentralen ischämischen Defiziten hingewiesen zu haben.…”

Section: Diskussionunclassified

Seltene Ursache multipler ipsilateraler Hirnnervenausfälle

1999

Swiss Arch Neurol Psychiatr

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“…4 The hypoglossal nerve (CN XII) is most commonly affected. 4,5 Less commonly, the V, VII, IX, X, and XI cranial nerves may also be involved. Ocular cranial nerve involvement has been described in intracranial CAD or progression of extracranial CAD (e.g., III, V, VI, affecting the cavernous segment of the ICA).…”

Section: 2mentioning

confidence: 99%

“…Ocular cranial nerve involvement has been described in intracranial CAD or progression of extracranial CAD (e.g., III, V, VI, affecting the cavernous segment of the ICA). 4,5 Cranial nerve palsies from CAD are usually explained by 2 mechanisms: 1) mechanical compression or stretching of the cranial nerves below the jugular foramen by the expanded artery or aneurysmal dilation at the origin of the dissection, 6 or 2) impairment, transient or permanent, of the blood supply to the cranial nerves. 4,5 CN XII has only a somatic motor (general somatic efferent) component innervating all the intrinsic and 3 of the 4 extrinsic muscles of the tongue, including genioglossus, styloglossus, and hyoglossus.…”

Section: 2mentioning

confidence: 99%

Pearls and Oy-sters: Carotid dissection with normal arterial lumen

Pongmoragot¹,

Bharatha²,

Saposnik³

2013

Neurology

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OY-STERS• CT angiogram with normal luminal diameter constitutes a challenge for the diagnosis of CAD in the emergency department. The identification of enlargement or thickening along the wall of the internal carotid artery should be sought in patients with suspected CAD. MRI (axial T1 with a fat saturation technique) is the most sensitive test to identify arterial wall changes and confirm the diagnosis.CASE REPORT A 60-year-old man presented to the emergency department complaining he could not whistle and had difficulty moving his tongue. The previous day he had developed sudden onset of left-side headache that remained present until his admission. The day of admission, he noticed that his tongue was deviated to the left side ( figure, A), causing swallowing difficulties. He denied any other neurologic symptoms. Past medical history was remarkable for mild hypertension. He denied high-speed neck manipulation. He acknowledged lifting of heavy boxes in the past 2 weeks. Neurologic examination revealed tongue deviated to the left suggestive of left hypoglossal nerve palsy. The remaining neurologic examination was unremarkable. Unenhanced head CT showed crescentic hyperdensity within the upper cervical internal carotid artery (ICA) at the skull base, suggesting dissection with intramural hematoma (figure, B). CT angiogram showed a cuff of abnormal soft tissue along the periphery of the vessel wall (figure, C) with preservation of luminal diameter. Dissection was confirmed with MRI brain (figure, D) which showed T1 hyperintensity (indicating intramural methemoglobin) within the wall of the internal carotid artery. There was no cerebral infarction. The patient was given aspirin 81 mg once daily. He recovered completely within 2 months.DISCUSSION Cervical artery dissection is a common cause of stroke in young and middle-aged adults.

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Cranial nerve palsies in spontaneous carotid artery dissection.

Cited by 128 publications

References 32 publications

Facial Diplegia Complicating a Bilateral Internal Carotid Artery Dissection

Facial Diplegia Complicating a Bilateral Internal Carotid Artery Dissection

Seltene Ursache multipler ipsilateraler Hirnnervenausfälle

Pearls and Oy-sters: Carotid dissection with normal arterial lumen

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