CRANIAL NERVE PALSY IN SPONTANEOUS DISSECTION OF THE EXTRACRANIAL INTERNAL CAROTID-ARTERY

Cranial nerve palsy was present in 23 of 190 consecutive adult patient s (12%) with spontaneous dissection of the extracranial internal carot id artery. Ten patients (5.2%) had a syndrome of lower cranial nerve p alsies (with invariable involvement of cranial nerve XII with or witho ut additional involvement of cranial nerves XI, X, and IX), seven (3.7 %) had palsy of cranial nerve V, and five (2.6%) had a syndrome of ocu lar motor palsies. Palsy of cranial nerve VIII and ischemic optic neur opathy occurred in one patient each. Three patients had dysgeusia with out other cranial nerve involvement, presumably due to involvement of the chorda tympani nerve. Headache or face pain (often unilateral) was present in 83% of patients. Other associated manifestations were cere bral ischemic symptoms, bruits, or oculosympathetic palsy. In one pati ent, cranial nerve palsy was the only manifestation of internal caroti d artery dissection, and in another patient, the disease presented onl y as a palsy of cranial nerve XII and oculosympathetic palsy. In six p atients, a syndrome of hemicrania and ipsilateral cranial nerve palsy was the sole manifestation of internal carotid artery dissection. Cran ial nerve palsy is not rare in internal carotid artery dissection. Com pression or stretching of the nerve by the expanded artery may explain some but not all of the palsies. An alter native mechanism is likely interruption of the nutrient vessels supplying the nerve.