Journal of Neurology, Neurosurgery, and Psychiatry, 1993, Vol 56, 1191-1199

PAPERS

Cranial nerve palsies in spontaneous carotid artery dissection

M Sturzenegger and P Huber
Department of Neurology, University of Berne, Inselspital, Switzerland.

Two patients had isolated unilateral cranial nerve palsies due to spontaneous internal carotid artery (ICA) dissection without ischaemic cerebral involvement. One had acute glossopharyngeal and vagal, the other isolated hypoglossal nerve palsy. Reviewing all reported cases of angiographically confirmed ICA dissection in the literature, 36 additional cases with unequivocal ipsilateral cranial nerve palsies were analysed. While an isolated palsy of the IXth and Xth has not been reported previously, palsies of the XIIth nerve or the IXth to XIIth nerves were most frequently found. In these patients, lower cranial nerve palsies are probably the result of compression by an enlarging ICA due to mural haematoma. Symptoms and signs indicative of carotid dissection were concurrently present only in some reported cases. This raises the question of unrecognised carotid dissection as a cause of isolated cranial nerve palsies. When the dissection occurs in the subadventitial layer without relevant narrowing of the arterial lumen and when an aneurysm is thrombosed, angiography does not reliably yield the diagnosis. Therefore, carotid dissection might have been underestimated as a cause of isolated lower cranial nerve palsies before the advent of MRI. MRI demonstrates directly the extension of the wall haematoma in the axial and longitudinal planes. Some arteriopathies such as fibromuscular dysplasia and tortuosity make a vessel predisposed to dissection.

© 1993 by Journal of Neurology, Neurosurgery, and Psychiatry

This article has been cited by other articles:

				How Good at Neurology are you? - Answers Practical Neurology, June 1, 2005; 5(3): 188 - 188. [Abstract] [PDF]

				R. W. Baumgartner, M. Arnold, I. Baumgartner, M. Mosso, F. Gonner, A. Studer, G. Schroth, B. Schuknecht, and M. Sturzenegger Carotid dissection with and without ischemic events: Local symptoms and cerebral artery findings Neurology, September 11, 2001; 57(5): 827 - 832. [Abstract] [Full Text] [PDF]

				R. J. Wityk Stroke in a Healthy 46-Year-Old Man JAMA, June 6, 2001; 285(21): 2757 - 2762. [Abstract] [Full Text] [PDF]

				J. van Gijn and G. J. E. Rinkel Subarachnoid haemorrhage: diagnosis, causes and management Brain, February 1, 2001; 124(2): 249 - 278. [Abstract] [Full Text] [PDF]

				J Finsterer, J Strassegger, A Haymerle, and G Hagmuller Bilateral stenting of symptomatic and asymptomatic internal carotid artery stenosis due to fibromuscular dysplasia J. Neurol. Neurosurg. Psychiatry, November 1, 2000; 69(5): 683 - 686. [Abstract] [Full Text] [PDF]

				O. Gout, I. Bonnaud, A. Weill, A. Moulignier, J. J. Quenet, J. Moret, and P. Bakouche Facial Diplegia Complicating a Bilateral Internal Carotid Artery Dissection Stroke, March 1, 1999; 30(3): 681 - 686. [Abstract] [Full Text] [PDF]

				S. TAILLIBERT, B. BAZIN, and C. PIERROT-DESEILLIGNY Dysgeusia resulting from internal carotid dissection. A limited glossopharyngeal nerve palsy J. Neurol. Neurosurg. Psychiatry, May 1, 1998; 64(5): 691 - 692. [Full Text]