Spontaneous carotid dissection presenting lower cranial nerve palsies

Donata Guidetti, Anna Pisanello, Franco Giovanardi, Claudio Morandi, Giulio Zuccoli, Antonio Troiso

Research output: Contribution to journalArticle

26 Citations (Scopus)

Abstract

Cranial nerve palsy in internal carotid artery (ICA) dissection occurs in 3-12% of all patients, but in 3% of these a syndrome of hemicranias and ipsilateral cranial nerve palsy is the sole manifestation of ICA dissection, and in 0.5% of cases there is only cranial nerve palsy without headache. We present two cases of lower cranial nerve palsy. The first patient, a 49-year-old woman, developed left eleventh and twelfth cranial nerve palsies and ipsilateral neck pain. The angio-RM showed an ICA dissection with stenosis of 50%, beginning about 2 cm before the carotid channel. The patient was treated with oral anticoagulant therapy and gradually improved, until complete clinical recovery. The second patient, a 38-year-old woman, presented right hemiparesis and neck pain. The left ICA dissection, beginning 2 cm distal to the bulb, was shown by ultrasound scanning of the carotid and confirmed by MR angiogram and angiography with lumen stenosis of 90%. Following hospitalisation, 20 days from the onset of symptoms, paresis of the left trapezius and sternocleidomastoideus muscles became evident. The patient was treated with oral anticoagulant therapy and only a slight right arm paresis was present at 10 months follow-up. Cranial nerve palsy is not rare in ICA dissection, and the lower cranial nerve palsies in various combinations constitute the main syndrome, but in most cases these are present with the motor or sensory deficit due to cerebral ischemia, along with headache or Horner's syndrome. In the diagnosis of the first case, there was further difficulty because the cranial nerve palsy was isolated without hemiparesis, and the second case presented a rare association of hemiparesis and palsy of the eleventh cranial nerve alone. Compression or stretching of the nerve by the expanded artery may explain the palsies, but an alternative cause is also possible, namely the interruption of the nutrient vessels supplying the nerve, which in our patients is more likely.

Original languageEnglish
Pages (from-to)203-207
Number of pages5
JournalJournal of the Neurological Sciences
Volume184
Issue number2
DOIs
Publication statusPublished - Mar 1 2001

Fingerprint

Cranial Nerve Diseases
Internal Carotid Artery Dissection
Dissection
Paresis
Accessory Nerve
Neck Pain
Paralysis
Anticoagulants
Nerve Expansion
Angiography
Pathologic Constriction
Hypoglossal Nerve
Horner Syndrome
Headache Disorders
Women's Rights
Superficial Back Muscles
Brain Ischemia
Headache
Hospitalization
Arteries

Keywords

  • Carotid artery dissection
  • Eleventh cranial nerve
  • Lower cranial nerves
  • Twelfth cranial nerve

ASJC Scopus subject areas

  • Ageing
  • Clinical Neurology
  • Surgery
  • Developmental Neuroscience
  • Neurology
  • Neuroscience(all)

Cite this

Spontaneous carotid dissection presenting lower cranial nerve palsies. / Guidetti, Donata; Pisanello, Anna; Giovanardi, Franco; Morandi, Claudio; Zuccoli, Giulio; Troiso, Antonio.

In: Journal of the Neurological Sciences, Vol. 184, No. 2, 01.03.2001, p. 203-207.

Research output: Contribution to journalArticle

Guidetti, Donata ; Pisanello, Anna ; Giovanardi, Franco ; Morandi, Claudio ; Zuccoli, Giulio ; Troiso, Antonio. / Spontaneous carotid dissection presenting lower cranial nerve palsies. In: Journal of the Neurological Sciences. 2001 ; Vol. 184, No. 2. pp. 203-207.
@article{ff9e2124b21a4eedb15f1f4172839d91,
title = "Spontaneous carotid dissection presenting lower cranial nerve palsies",
abstract = "Cranial nerve palsy in internal carotid artery (ICA) dissection occurs in 3-12{\%} of all patients, but in 3{\%} of these a syndrome of hemicranias and ipsilateral cranial nerve palsy is the sole manifestation of ICA dissection, and in 0.5{\%} of cases there is only cranial nerve palsy without headache. We present two cases of lower cranial nerve palsy. The first patient, a 49-year-old woman, developed left eleventh and twelfth cranial nerve palsies and ipsilateral neck pain. The angio-RM showed an ICA dissection with stenosis of 50{\%}, beginning about 2 cm before the carotid channel. The patient was treated with oral anticoagulant therapy and gradually improved, until complete clinical recovery. The second patient, a 38-year-old woman, presented right hemiparesis and neck pain. The left ICA dissection, beginning 2 cm distal to the bulb, was shown by ultrasound scanning of the carotid and confirmed by MR angiogram and angiography with lumen stenosis of 90{\%}. Following hospitalisation, 20 days from the onset of symptoms, paresis of the left trapezius and sternocleidomastoideus muscles became evident. The patient was treated with oral anticoagulant therapy and only a slight right arm paresis was present at 10 months follow-up. Cranial nerve palsy is not rare in ICA dissection, and the lower cranial nerve palsies in various combinations constitute the main syndrome, but in most cases these are present with the motor or sensory deficit due to cerebral ischemia, along with headache or Horner's syndrome. In the diagnosis of the first case, there was further difficulty because the cranial nerve palsy was isolated without hemiparesis, and the second case presented a rare association of hemiparesis and palsy of the eleventh cranial nerve alone. Compression or stretching of the nerve by the expanded artery may explain the palsies, but an alternative cause is also possible, namely the interruption of the nutrient vessels supplying the nerve, which in our patients is more likely.",
keywords = "Carotid artery dissection, Eleventh cranial nerve, Lower cranial nerves, Twelfth cranial nerve",
author = "Donata Guidetti and Anna Pisanello and Franco Giovanardi and Claudio Morandi and Giulio Zuccoli and Antonio Troiso",
year = "2001",
month = "3",
day = "1",
doi = "10.1016/S0022-510X(01)00440-3",
language = "English",
volume = "184",
pages = "203--207",
journal = "Journal of the Neurological Sciences",
issn = "0022-510X",
publisher = "Elsevier",
number = "2",

}

TY - JOUR

T1 - Spontaneous carotid dissection presenting lower cranial nerve palsies

AU - Guidetti, Donata

AU - Pisanello, Anna

AU - Giovanardi, Franco

AU - Morandi, Claudio

AU - Zuccoli, Giulio

AU - Troiso, Antonio

PY - 2001/3/1

Y1 - 2001/3/1

N2 - Cranial nerve palsy in internal carotid artery (ICA) dissection occurs in 3-12% of all patients, but in 3% of these a syndrome of hemicranias and ipsilateral cranial nerve palsy is the sole manifestation of ICA dissection, and in 0.5% of cases there is only cranial nerve palsy without headache. We present two cases of lower cranial nerve palsy. The first patient, a 49-year-old woman, developed left eleventh and twelfth cranial nerve palsies and ipsilateral neck pain. The angio-RM showed an ICA dissection with stenosis of 50%, beginning about 2 cm before the carotid channel. The patient was treated with oral anticoagulant therapy and gradually improved, until complete clinical recovery. The second patient, a 38-year-old woman, presented right hemiparesis and neck pain. The left ICA dissection, beginning 2 cm distal to the bulb, was shown by ultrasound scanning of the carotid and confirmed by MR angiogram and angiography with lumen stenosis of 90%. Following hospitalisation, 20 days from the onset of symptoms, paresis of the left trapezius and sternocleidomastoideus muscles became evident. The patient was treated with oral anticoagulant therapy and only a slight right arm paresis was present at 10 months follow-up. Cranial nerve palsy is not rare in ICA dissection, and the lower cranial nerve palsies in various combinations constitute the main syndrome, but in most cases these are present with the motor or sensory deficit due to cerebral ischemia, along with headache or Horner's syndrome. In the diagnosis of the first case, there was further difficulty because the cranial nerve palsy was isolated without hemiparesis, and the second case presented a rare association of hemiparesis and palsy of the eleventh cranial nerve alone. Compression or stretching of the nerve by the expanded artery may explain the palsies, but an alternative cause is also possible, namely the interruption of the nutrient vessels supplying the nerve, which in our patients is more likely.

AB - Cranial nerve palsy in internal carotid artery (ICA) dissection occurs in 3-12% of all patients, but in 3% of these a syndrome of hemicranias and ipsilateral cranial nerve palsy is the sole manifestation of ICA dissection, and in 0.5% of cases there is only cranial nerve palsy without headache. We present two cases of lower cranial nerve palsy. The first patient, a 49-year-old woman, developed left eleventh and twelfth cranial nerve palsies and ipsilateral neck pain. The angio-RM showed an ICA dissection with stenosis of 50%, beginning about 2 cm before the carotid channel. The patient was treated with oral anticoagulant therapy and gradually improved, until complete clinical recovery. The second patient, a 38-year-old woman, presented right hemiparesis and neck pain. The left ICA dissection, beginning 2 cm distal to the bulb, was shown by ultrasound scanning of the carotid and confirmed by MR angiogram and angiography with lumen stenosis of 90%. Following hospitalisation, 20 days from the onset of symptoms, paresis of the left trapezius and sternocleidomastoideus muscles became evident. The patient was treated with oral anticoagulant therapy and only a slight right arm paresis was present at 10 months follow-up. Cranial nerve palsy is not rare in ICA dissection, and the lower cranial nerve palsies in various combinations constitute the main syndrome, but in most cases these are present with the motor or sensory deficit due to cerebral ischemia, along with headache or Horner's syndrome. In the diagnosis of the first case, there was further difficulty because the cranial nerve palsy was isolated without hemiparesis, and the second case presented a rare association of hemiparesis and palsy of the eleventh cranial nerve alone. Compression or stretching of the nerve by the expanded artery may explain the palsies, but an alternative cause is also possible, namely the interruption of the nutrient vessels supplying the nerve, which in our patients is more likely.

KW - Carotid artery dissection

KW - Eleventh cranial nerve

KW - Lower cranial nerves

KW - Twelfth cranial nerve

UR - http://www.scopus.com/inward/record.url?scp=0035282813&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0035282813&partnerID=8YFLogxK

U2 - 10.1016/S0022-510X(01)00440-3

DO - 10.1016/S0022-510X(01)00440-3

M3 - Article

C2 - 11239957

AN - SCOPUS:0035282813

VL - 184

SP - 203

EP - 207

JO - Journal of the Neurological Sciences

JF - Journal of the Neurological Sciences

SN - 0022-510X

IS - 2

ER -