Document Detail

Internal carotid artery dissection heralded by an oculomotor nerve palsy: case report and literature review.
MedLine Citation:
PMID:  22045285     Owner:  NLM     Status:  MEDLINE    
INTRODUCTION: Acute oculomotor nerve (CN III) palsies are commonly attributed to microvascular disease or compressive lesions and aneurysms, but may rarely be associated with ischemic large vessel disease. We report a case of an extracranial internal carotid artery (ICA) dissection heralded by CN III palsy with review of the relevant literature.
CASE REPORT: A 24-year-old right-handed man presented with right-sided weakness preceded by vomiting 2 days earlier. The following day, the family noted his left eye to be deviated outward with enlarged pupil and droopy eyelid. On the day of admission, he had a fall owing to right-sided weakness. His neurological examination revealed significant aphasia, left third nerve palsy, right homonymous hemianopsia, and right-sided hemiplegia with hemisensory deficits. A brain magnetic resonance image showed an acute ischemic infarct in the left middle cerebral artery distribution without mass effect. Magnetic resonance angiogram showed a left extracranial internal cerebral artery (ICA) dissection with absence of flow within the distal cervical and intracranial ICA segments. He underwent a decompressive left hemicraniectomy with partial improvement in his deficits.
DISCUSSION: Oculomotor nerve palsy as a result of ICA disease is a rare entity but has been reported in cases of stenosis, occlusion, and dissection. It is likely to be caused by hypoperfusion of CN III secondary to low flow or microembolism in the arteries feeding the nerve. The risk of CN III palsy in patients with ICA disease is higher in the presence of a fetal posterior cerebral artery.
CONCLUSIONS: Acute oculomotor nerve palsies with pupillary involvement warrant thorough investigation. When routine work-up fails to elucidate an etiology, extracranial carotid pathology should be considered.
Ahmad Nizam; Hussam A Yacoub; James S McKinney
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Publication Detail:
Type:  Case Reports; Journal Article    
Journal Detail:
Title:  The neurologist     Volume:  17     ISSN:  2331-2637     ISO Abbreviation:  Neurologist     Publication Date:  2011 Nov 
Date Detail:
Created Date:  2011-11-02     Completed Date:  2012-02-23     Revised Date:  2014-11-05    
Medline Journal Info:
Nlm Unique ID:  9503763     Medline TA:  Neurologist     Country:  United States    
Other Details:
Languages:  eng     Pagination:  333-7     Citation Subset:  IM    
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MeSH Terms
Carotid Artery, Internal, Dissection / complications*,  diagnosis,  pathology,  surgery
Decompressive Craniectomy
Diffusion Magnetic Resonance Imaging
Magnetic Resonance Angiography
Oculomotor Nerve Diseases / diagnosis,  etiology*,  surgery
Tomography, X-Ray Computed
Young Adult

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