CRANIAL NERVE PALSIES DUE TO INTERNAL CAROTID-ARTERY DISSECTION - 7 CASES

Cranial nerve palsies are rare complications of internal carotid arter y (ICA) dissections. The aim of this study is to evaluate the incidenc e of cranial nerve palsies in consecutive patients with ICA dissection and to describe clinical and radiological characteristics and their e volution over time. This study was conducted in 52 consecutive patient s with dissection of the ICA. We have analyzed clinical data of patien ts with cranial nerve palsy as complication of ICA dissection. We defi ned ICA dissection as angiographic evidence of a string sign, double l umen, or internal flaps or visualization on magnetic resonance imaging (MRI) or computed tomographic scans of an enlarged arterial wall due to the hematoma. Of 52 consecutive patients with ICA dissection 7 had cranial nerve palsies : 2 had an involvement of the Vth cranial nerve and 5 had lower cranial nerve palsies. Five patients totally recovered while 2 did not after a 2 to 10-month period. The frequency of crania l nerve palsies associated with ICA dissection is higher in our study than in those of the literature. Many patients presenting with cranial nerve palsies due to ICA dissection without any ischemic event are pr obably not referred to stroke units. Angiography is less sensitive tha n cervical MRI to detect such patients. Cranial nerve palsies could ei ther be due to compression by the enlarged ICA wall or an ischemia of the nerve.