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Spontaneous Internal Carotid Artery Dissection with Lower Cranial Nerve Palsy

Published online by Cambridge University Press:  02 December 2014

N. Guy ,
D. Deffond ,
N. Carriere ,
G. Dordain ,
P. Clavelou  and
J. Gabrillargues
N. Guy
Affiliation:
Fédération de Neurologie, CHU de Clermont Ferrand, Clermont Ferrand, France
D. Deffond
Affiliation:
Fédération de Neurologie, CHU de Clermont Ferrand, Clermont Ferrand, France
N. Carriere
Affiliation:
Fédération de Neurologie, CHU de Clermont Ferrand, Clermont Ferrand, France
G. Dordain
Affiliation:
Fédération de Neurologie, CHU de Clermont Ferrand, Clermont Ferrand, France
P. Clavelou
Affiliation:
Fédération de Neurologie, CHU de Clermont Ferrand, Clermont Ferrand, France
J. Gabrillargues
Affiliation:
Service de, Neuroradiologie, CHU de Clermont Ferrand, Clermont Ferrand, France
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Abstract

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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.

Résumé:

RÉSUMÉ:Introduction:

Le diagnostic de dissection de l'artère carotide interne (ACI) est le plus souvent évoqué devant l'association d'une douleur cervicale et d'un syndrome de Horner homolatéraux associés à un déficit moteur de l'hémicorps controlatéral. Plus rarement, une dissection carotidienne peut s'accompagner d'une paralysie homolatérale des derniers nerfs crâniens.

Etude de cas:

Nous décrivons 3 nouveaux cas de paralysie des derniers nerfs crâniens associée à une dissection de l'ACI.

Résultats:

Dans les trois cas une douleur céphalique fut le premier signe à apparaître, l'examen clinique mit en évidence un signe de Horner chez deux patients (1 et 2), une paralysie isolée du XIIe dans deux cas (1 et 3), et des IXe, Xe, Xlle nerfs crâniens dans un cas (2). Le diagnostic de dissection de l'ACI homolatérale fut confirmé par l'IRM et l'angiographie. L'évolution fut favorable en quelques semaines dans les trois cas.

Conclusions:

En analysant ces trois observations conjointement avec celles de la littérature, deux hypothèses physiopathologiques peuvent être proposées: un mécanisme compressif direct ou un mécanisme ischémique par compression de l'artère pharyngienne ascendante.

Type
Case Report
Information
Canadian Journal of Neurological Sciences , Volume 28 , Issue 3 , August 2001 , pp. 265 - 269
Copyright
Copyright © The Canadian Journal of Neurological 2001

References

1. Anderson, RM, Schechter, MM. A case of spontaneous dissectinganeurysm of the internal carotid artery. J Neurol Neurosurg Psychiatry 1959; 22: 195–201.Google Scholar
2. Thommasi-Davenas, C, Vighetto, A, Confavreux, C, Aimard, G. Causes des paralysies du nerf grand hypoglosse. Presse Med 1989; 864–868.Google Scholar
3. Kramer, W. Hyperplasie fibromusculaire et anévrysme extracraniende la carotide interne avec syndrome parapharyngien typique. Rev Neurol 1969; 4: 239–244.Google Scholar
4. Sturzenegger, M, Huber, P. Cranial nerve palsy in spontaneouscarotid artery dissection. J Neurol Neurosurg Psychiatry 1993;56: 1191–1199.CrossRefGoogle ScholarPubMed
5. Hommel, M, Pollack, P, Gaio, JM, et al. Paralysies du nerf grandhypoglosse par deux anévrysmes et un anévrysme disséquant de la carotide interne. Rev Neurol 1984; 6–7: 415–421.Google Scholar
6. Bradac, GB, Kaernbach, A, Bolk-Weichedel, D, Finck, GA. Spontaneous dissecting aneurysm of cervical cerebral artery. Neuroradiology 1981; 21: 149–154.Google Scholar
7. Bradac, GB, Riva, A, Stura, G, Doriguzz, C. Dissection spontanée dela carotide interne avec paralysie du XII. J Neuroradiol 1989; 16: 197–202.Google Scholar
8. Vighetto, A, Lisovoski, F, Revol, A, Trillet, M, Aimard, G. Internalcarotid artery dissection and ipsilateral hypoglossal nerve palsy. JNeurol Neurosurg Psychiatry 1990; 53: 530–531.CrossRefGoogle Scholar
9. Goodman, JM, William, LZ, Cooper, DF. Hemilingual paralysiscaused by spontaneous carotid artery dissection. Arch Neurol 1983; 40: 653–654.Google Scholar
10. Dal Pozzo, G, Mascalchi, M, Fonda, C, et al. Lower cranial nervepalsy due to dissection of the internal carotid artery: CT and MR imaging. J Comput Assist Tomogr 1989; 13: 989–995.Google Scholar
11. Goldberg, HI, Grossman, RI, Gomori, JM, et al. Cervical internalcarotid artery dissecting hemorrhage: diagnosis using MR. Radiology 1986; 158: 157–161.Google Scholar
12. Panisset, M, Eidelman, BH. Multiple cranial neuropathy as a featureof internal carotid artery dissection. Stroke 1990; 21: 141–147.Google Scholar
13. Gros, G,Vlahovitch, B, Labauge, R, et al. Les anévrysmes extra-craniens de la carotide interne. Neurochirurgie 1970; 5: 367–382.Google Scholar
14. Taillibert, S, Bazin, B, Pierrot-Deseilligny, C. Dysgueusia resultingfrom internal carotid dissection. A limited glossopharyngeal palsy. J Neurol Neurosurg Psychiatry 1998; 64: 691–692.Google Scholar
15. Vanneste, JAL, Davies, G. Spontaneous dissection of the cervicalinternal carotid artery. Clin Neurol Neurosurg 1984; 86–4: 307–314.Google ScholarPubMed
16. Koch, J, Klotz, JM, Kahle, G, Langohr, HD. Unilateral lower cranialnerve palsies caused by extracranial carotid artery dissection. Fortschr Neurol Psychiat 1994; 62: 46–49.Google Scholar
17. Klossek, JM, Vandenmarq, P. Unilateral lower cranial nerve palsiesdue to spontaneous internal carotid artery dissection. Ann Otol Rhinol Laryngol 1994;103: 413–415.Google Scholar
18. Auzou P, Hannequin D, Patrux B, et al. Atteinte du grandhypoglosse révélant une dissection de l’artère carotide interne. Ann Otolaryngol Chir Cervicofac 1996; 113: 45–47.Google Scholar
19. Schmidt, F, Dihne, M, Steinbach, J, Burhing, U, Kuker, W. Raeder andCollet-Sicard syndrome. Acute paresis of cranial nerves symptomatic of a dissection of internal carotid artery. Nervenarzt 2000; 71: 502–505.Google Scholar
20. Waespe, W, Niesper, J, Imhof, HG, Valavanis, A. Lower cranial nervepalsy due to internal carotid dissection. Stroke 1988; 19: 1561–1564.CrossRefGoogle Scholar
21. Mokri, B,Sundt, TM, Houser, OW, Piepgras, DG. Spontaneousdissection of the cervical internal carotid artery. Ann Neurol 1986; 19: 126–138.CrossRefGoogle ScholarPubMed
22. Rees, JH, Valentine, AR, Llewelyn, JG. Spontaneous bilateral carotidand vertebral artery dissection presenting as a Collet-Sicardsyndrome. Brit J Radiol 1997; 70: 856–858.CrossRefGoogle Scholar
23. Lieshke, GJ, Davis, S, Tress, BM, Ebeling, P. Spontaneous internalcarotid artery dissection presenting as hypoglossal nerve palsy. Stroke 1988; 19: 1151–1155.CrossRefGoogle Scholar
24. Ruiz, J, Varona, L, Martin-Gomez, JI, et al. Diseccion espontannea dela arteria carotida interna como causa de paralisis de pares craneales bulbares. Neurologia 1995; 10: 391–393.Google Scholar
25. Nusbaum, AO, Som, PM, Dubois, P, Silvers, A. Isolated vagal nervepalsy associated with a dissection of the extracranial internalcarotid artery. Am J Neuroradiol 1998; 19: 1845–1847.Google Scholar
26. Wannebroucq, J, Petyt, L, Cassim, JF, Rondepierre, PH, Pruvo JPDissection de l’artère carotide interne révélée par une paralysie isolée des IX, X, XI nerfs craniens. Rev Im Med 1993; 5: 495–497.Google Scholar
27. Zipp, F, Herdt, P, Goetz, GF, et al. Isolierte einseitige hypoglossus-parese bei karotisdissektion. Nervenarzt 1993;64: 535–538.Google Scholar
28. Moussouttas, M, Tuhrim, S. Spontaneous internal carotid arterydissection with isolated vagus nerve deficit. Neurology 1998; 51: 317–318.Google Scholar
29. Anzola, GP, Gualandi, GF, Orlandini, A, Scipione, V. Lower cranialnerve palsy produced by internal carotid artery dilatation. Reportof two cases. Ital J Neurol Sci 1987; 8: 375–379.CrossRefGoogle Scholar
30. Hess, D, Sethi, KD, Nichols, FT. Carotid dissection: a new falselocalising sign. J Neurol Neurosurg Psychiatry 1990; 53: 804–805.Google Scholar
31. Boukobza, M. Internal carotid artery dissection causes hypoglossalnerve palsy: CT, MRI, and angiographic findings. J Neuroimag 1998; 8: 244–246.Google Scholar
32. Serre, I, Delattre, JY, Poisson, M. Dissection carotidienne et paralysiehomolatérale du XII. Ann Med Interne (Paris) 1993; 7: 500–502.Google Scholar
33. Davies, L. A vagal palsy due to dissecting aneurysm of the carotidartery. Med J Aust 1987; 147: 352–353.CrossRefGoogle Scholar
34. Heckmann, JG, Tomandl, B, Stefan, H, Neundôrfer, B. Collet-Sicardsyndrome due to coiling and dissection of internal carotid artery. Cerebrovasc Dis 2000; 10: 487–488.CrossRefGoogle Scholar
35. De Brouker, T, Lacombe, H, Danziger, N, Baril, P, Sangla, S. Paralysieunilatérale des derniers nerfs craniens par lésion de l’artèrecarotide interne. Rev Neurol 1994; 150: 850–853.Google Scholar
36. Gauthier, G, Rohr, J, Wildi, E, Megret, M. L’hématome disséquantspontané de l’artère carotide interne. Arch Suisses NeurolPsychiatr 1985; 136: 53–74.Google Scholar
37. Hart, RG, Easton, DJ. Dissections of cervical and cerebral arteries. Barnett, HJM (ed). Cerebrovascular Disease. Neurol Clin 1983; 1 155–182.Google ScholarPubMed
38. Lasjaunias, P, Doyon, D. L’artère pharyngienne ascendante dans lavascularisation des dernières paires craniennes (IX, X,XI, XII). JNeuroradiology 1978; 5: 287–301.Google Scholar
39. Lapresle, J, Lasjaunias, P. Cranial nerve ischaemic arterial syndromes- A review. Brain 1986; 109: 207–215.Google Scholar
40. Scotti, G, Melancon, D, Olivier, A. Hypoglossal paralysis due tocompression by a tortuous internal carotid artery in the neck. Neuroradiology 1978; 14: 263–265.Google Scholar
41. Havelius, U, Hindfelt, B, Brismar, J, Cronqvist, S. Carotid fibro-muscular dysplasia and paresis of lower cranial nerves (Collet-Sicard syndrome). Case report. J Neurosurg 1982; 56: 850–853.Google Scholar
42. Theodotou, B, Mahaley, MS. Injury of the peripheral cranial nervesduring carotid endarterectomy. Stroke 1985; 16: 894–895.Google Scholar
43. Maniglia, AJ, Peter-Han, D. Cranial nerve injuries following carotidendarterectomy: an analysis of 336 procedures. Head Neck 1991; 13(2): 121–124.Google Scholar