scholarly journals Unruptured Large and Giant Carotid Artery Aneurysms Presenting with Cranial Nerve Palsy: Comparison of Clinical Recovery after Selective Aneurysm Coiling and Therapeutic Carotid Artery Occlusion

2008 ◽  
Vol 29 (5) ◽  
pp. 997-1002 ◽  
Author(s):  
W.J. van Rooij ◽  
M. Sluzewski
Keyword(s):  
Carotid Artery ◽  
Cranial Nerve ◽  
Cranial Nerve Palsy ◽  
Nerve Palsy ◽  
Artery Occlusion ◽  
Carotid Artery Occlusion ◽  
Clinical Recovery ◽  
Aneurysm Coiling

Pseudomyasthenia Resulting from a Posterior Carotid Artery Wall Aneurysm: A Novel Presentation: Case Report

Neurosurgery ◽  
2001 ◽  
Vol 49 (6) ◽  
pp. 1466-1469 ◽  
Author(s):  
Ramachandra P. Tummala ◽  
Andrew Harrison ◽  
Michael T. Madison ◽  
Eric S. Nussbaum
Keyword(s):  
Carotid Artery ◽  
Cranial Nerve ◽  
Cranial Nerve Palsy ◽  
Intracranial Aneurysms ◽  
Nerve Palsy ◽  
Oculomotor Nerve ◽  
Artery Wall ◽  
Carotid Artery Wall ◽  
Cranial Nerve Dysfunction ◽  
Cranial Nerve Palsies

ABSTRACT OBJECTIVE AND IMPORTANCE Painful oculomotor palsy can result from enlargement or rupture of intracranial aneurysms. The IIIrd cranial nerve dysfunction in this setting, whether partial or complete, is usually fixed or progressive and is sometimes reversible with surgery. We report an unusual oculomotor manifestation of a posterior carotid artery wall aneurysm, which mimicked ocular myasthenia gravis. CLINICAL PRESENTATION A 47-year-old woman developed painless, intermittent, partial IIIrd cranial nerve palsy. She presented with isolated episodic left-sided ptosis, which initially suggested a metabolic or neuromuscular disorder. However, digital subtraction angiography revealed a left posterior carotid artery wall aneurysm, just proximal to the origin of the posterior communicating artery. INTERVENTION The aneurysm was successfully clipped via a pterional craniotomy. During surgery, the aneurysm was observed to be compressing the oculomotor nerve. The patient's symptoms resolved after the operation. CONCLUSION The variability of incomplete IIIrd cranial nerve deficits can present a diagnostic challenge, and the approach for patients with isolated IIIrd cranial nerve palsies remains controversial. Although intracranial aneurysms compressing the oculomotor nerve classically produce fixed or progressive IIIrd cranial nerve palsies with pupillary involvement, anatomic variations may result in atypical presentations. With the exception of patients who present with pupil-sparing but otherwise complete IIIrd cranial nerve palsy, clinicians should always consider an intracranial aneurysm when confronted with even subtle dysfunction of the oculomotor nerve.

scholarly journals Efficacy of Endovascular Surgery for Unruptured Internal Carotid Artery Aneurysms Presenting with Cranial Nerve Symptoms

2007 ◽  
Vol 13 (1_suppl) ◽  
pp. 163-169 ◽  
Author(s):  
S. Suzuki ◽  
A. Kurata ◽  
S. Kan ◽  
M. Yamada ◽  
J. Niki ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Cranial Nerve ◽  
Cranial Nerve Palsy ◽  
Complete Resolution ◽  
Nerve Palsy ◽  
Internal Carotid ◽  
Endovascular Surgery ◽  
Detachable Coils ◽  
The Mean

Whether endovascular surgery is able to reduce the mass effects of unruptured aneurysms is still controversial, although some reports have suggested efficacy in cases of internal carotid artery aneurysms with cranial nerve palsy. Here we assessed outcome in a series of cases. Between April 1992 and April 2005, 18 patients with unruptured internal carotid artery aneurysms presenting with cranial nerve palsy were treated by endovascular surgery. The patients were two males and 16 females aged from 19 to 84 (mean 59.6 years). Aneurysms were located in the cavernous portion in 14, at the origin of the ophthalmic artery in one and at the origin of P-com in three. The aneurysms were all embolized using Guglielmi detachable coils, Interlocking detachable coils, Cook's detachable coils or Trufill DSC and detachable Balloons were applied to occlude the proximal parent artery. We analyzed the efficacy of endovascular surgery for such aneurysms retrospectively. The mean aneurysm size was 21.4 mm and the mean follow-up period was 57.7 months. Palsy of IInd cranial nerve was evident in three patients, of the IIIrd in eight, of the Vth and Vth in one each, and of the VIth in nine. Post embolization occlusion was complete in nine patients and neck remnant in the other seven. Regarding complications of endovascular surgery, one case (5.6%) showed TIA after embolization. Overall 11 (46%) cranial nerve symptoms showed complete resolution, eight (33%) showed some improvement, and five (21%) were unchanged. In three cases (12.5%), the symptoms worsened after treatment. The shorter the duration of symptoms was a factor predisposing to resolution of symptoms. In complete resolution cases, the timing of treatment after symptoms appeared and the time of complete resolution were in proportion. These results showed that there is no difference in reduction of mass effects between surgical clipping and endovascular surgery for unruptured internal carotid artery aneurysms. With endovascular surgery, the rapidity of treatment after symptoms is the most important factor for successful results.

scholarly journals Spontaneous Internal Carotid Artery Dissection with Lower Cranial Nerve Palsy

2001 ◽  
Vol 28 (3) ◽  
pp. 265-269 ◽  
Author(s):  
N. Guy ◽  
D. Deffond ◽  
N. Carriere ◽  
G. Dordain ◽  
P. Clavelou ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Cranial Nerve ◽  
Cranial Nerve Palsy ◽  
Nerve Palsy ◽  
Internal Carotid ◽  
Horner’S Syndrome ◽  
Horner's Syndrome ◽  
Lower Cranial Nerve ◽  
Lower Cranial Nerve Palsy

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.

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