Spontaneous Internal Carotid Artery Dissection with Lower Cranial Nerve Palsy

Abstract

Background:Typical presentation of spontaneous internal carotid artery (ICA) dissection is an ipsilateral pain in neck and face with Horner's syndrome and contralateral deficits. Although rare, lower cranial nerve palsy have been reported in association with an ipsilateral spontaneous ICA dissection.Case studies:We report three new cases of ICA dissection with lower cranial nerve palsies.Results:The first symtom to appear was headache in all three patients. Examination disclosed a Horner's syndrome in two cases (1 and 2), an isolated XIIth nerve palsy in two patients (case 1 and 3) and IX, X, and XIIth nerve palsies (case 2) revealing an ipsilateral carotid dissection, confirmed by MRI and angiography. In all cases, prognosis was good after a few weeks.Conclusion:These cases, analysed with those in the literature, led us to discuss two possible mechanisms: direct compression of cranial nerves by a subadventitial haematoma in the parapharyngeal space or ischemic palsy by compression of the ascending pharyngeal artery.

Current pharmacologic testing for horner syndrome

“…Symptoms that may follow an ICA dissection include periorbital and facial pain, ipsilateral visual loss, ipsilateral hemicranial headache, and Horner syndrome following trauma [27,28]. The carotid plexus is compressed by hematoma.…”

Upper cranial nerve palsy resulting from spontaneous carotid dissection

“…UCNP have been reported ipsilateral to internal carotid artery (ICA) stenosis [6,7]. However, owing to the high prevalence of cardiovascular risk factors in this patient group a clear distinction between microangiopathic damage associated with the underlying risk factors and a hypoperfusion caused by the ICA stenosis is often not possible.We present two cases of upper cranial nerve palsy due to spontaneous internal JON 1673 ■ Abstract Introduction Upper cranial nerve palsy has a variety of causes such as cerebral and nerve ischemia, diabetes, infectious and non-infectious meningitis, subarachnoid hemorrhage and intracranial aneurysm.…”

“…Typical presentation of spontaneous ICA dissection is an ipsilateral pain in the neck and face with Horner's syndrome and contralateral neurological deficits.Lower cranial nerve palsies have been reported to be associated with ipsilateral ICA dissection [6][7][8]. Cranial nerve palsy occurs in 3 to 12 % of all patients suffering from ICA dissection,but in 3 % it is the only presenting sign besides headaches,and in 0.5 % of cases only cranial nerve palsies without headache are found [1,9,10].…”

Successfully Treated with Endovascular Therapy against Lower Cranial Nerve Paresis Caused by Spontaneous Dissection of the Cervical Internal Carotid Artery: A Case Report

“…There were 29 patients with idiopathic dissection of the cervical internal carotid artery and inferior cranial neuropathy, as presented in Table 1. [5][6][7][8][9][10][11][12][13][14] The proportion of males was high (86%, n = 25). The mean age was 46.6 years (28-63 years).…”