Kogan Michael, Natarajan Sabareesh K, Kim Nina, Sawyer Robert N, Snyder Kenneth V, Siddiqui Adnan H
Department of Neurosurgery, School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, USA ; Department of Neurosurgery, Gates Vascular Institute-Kaleida Health, New York, USA.
Department of Neurology, School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, USA ; Department of Neurology, Gates Vascular Institute-Kaleida Health, Buffalo, New York, USA.
Surg Neurol Int. 2014 Nov 28;5(Suppl 14):S497-500. doi: 10.4103/2152-7806.145653. eCollection 2014.
Common causes of oculomotor nerve palsy are diabetes, aneurysmal compression, and uncal herniation. A lesser-known cause of third nerve dysfunction is ischemia, often due to carotid artery dissection.
An 80-year-old man presented with an acute ischemic stroke with a National Institutes of Health Stroke Scale score of >20 from a high cervical internal carotid artery (ICA) dissection and a tandem ICA terminus embolic occlusion with extension of clot into the adjacent fetal posterior cerebral artery (PCA). We used a stentriever to perform selective PCA thrombectomy, with immediate postthrombectomy development of ipsilateral anisocoria. The anisocoria progressed into complete oculomotor nerve palsy over 8 h after the procedure.
The clinical course described in this case is consistent with injury to the third nerve due to mechanical injury or occlusion of perforator supply to the nerve during thrombectomy. Oculomotor nerve palsy is a rare but known complication after ischemia; however, to our knowledge, this is the first case after thrombectomy for a PCA embolus.
动眼神经麻痹的常见病因包括糖尿病、动脉瘤压迫和钩回疝。动眼神经功能障碍的一个鲜为人知的病因是缺血，通常由颈动脉夹层引起。
一名80岁男性因高位颈内动脉夹层导致急性缺血性卒中，美国国立卫生研究院卒中量表评分>20，同时存在串联的颈内动脉末端栓子闭塞，血栓延伸至相邻的胎儿型大脑后动脉（PCA）。我们使用取栓支架进行选择性PCA取栓术，取栓术后立即出现同侧瞳孔不等大。术后8小时内，瞳孔不等大进展为完全性动眼神经麻痹。
本病例所描述的临床过程与取栓术中神经受到机械损伤或穿支供血闭塞导致动眼神经损伤一致。动眼神经麻痹是缺血后一种罕见但已知的并发症；然而，据我们所知，这是PCA栓子取栓术后的首例病例。
