Gobert M, Mounier-Vehier F, Lucas C, Leclerc X, Leys D
Department of Neurology, University Hospital Lille, France.
Acta Neurol Belg. 1996 Mar;96(1):55-61.
Cranial nerve palsies are rare complications of internal carotid artery (ICA) dissections. The aim of this study is to evaluate the incidence of cranial nerve palsies in consecutive patients with ICA dissection and to describe clinical and radiological characteristics and their evolution over time. This study was conducted in 52 consecutive patients with dissection of the ICA. We have analyzed clinical data of patients with cranial nerve palsy as complication of ICA dissection. We defined ICA dissection as angiographic evidence of a string sign, double lumen, 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 cranial 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 probably not referred to stroke units. Angiography is less sensitive than cervical MRI to detect such patients. Cranial nerve palsies could either be due to compression by the enlarged ICA wall or an ischemia of the nerve.
颅神经麻痹是颈内动脉（ICA）夹层的罕见并发症。本研究的目的是评估连续的ICA夹层患者中颅神经麻痹的发生率，并描述其临床和放射学特征以及随时间的演变情况。本研究纳入了52例连续的ICA夹层患者。我们分析了以颅神经麻痹为ICA夹层并发症的患者的临床资料。我们将ICA夹层定义为血管造影显示的线样征、双腔或内膜瓣，或磁共振成像（MRI）或计算机断层扫描显示因血肿导致动脉壁增厚。在52例连续的ICA夹层患者中，7例出现颅神经麻痹：2例累及第V颅神经，5例累及低位颅神经。5例患者完全恢复，2例在2至10个月后未恢复。在我们的研究中，与ICA夹层相关的颅神经麻痹的发生率高于文献报道。许多因ICA夹层出现颅神经麻痹且无任何缺血事件的患者可能未被转诊至卒中单元。血管造影在检测此类患者方面不如颈部MRI敏感。颅神经麻痹可能是由于ICA壁增厚压迫所致，也可能是神经缺血所致。
