Abstract Details

Title Isolated Abducens Nerve Palsy as a Presentation of Extracranial Internal Carotid Artery Dissection: A Case Report

Topic Cerebrovascular Disease and Interventional Neurology

Presentation(s) P2 - Poster Session 2 (11:45 AM-12:45 PM)

Poster/Presentation
Number 13-007

Objective

To report a case of abducens nerve palsy as a rare manifestation of extracranial internal carotid artery (ICA) dissection.

Background Abducens nerve palsy is an extremely rare manifestation of ICA dissection.

Design/Methods

Single case study.

Results A 32-year-old healthy man presented to the hospital for horizontal diplopia. He was previously treated for a presumed complicated sinus infection after developing left eye and facial pain. He did not have history of head or neck trauma of any type. On exam, he had slight left eye esotropia, diplopia in upgaze, downgaze, and worse at leftgaze compatible with left abducens palsy. MRI brain did not show acute stroke but absent left internal carotid artery flow void from the skull base through its petrous segment. MRA and CTA findings were compatible with extracranial left ICA dissection. Diagnostic angiogram was performed and showed evidence of left distal ICA extracranial dissection but patent flow to distal ICA intracranial segment. He did not undergo any surgical or endovascular interventions. Patient’s clinical status remained unchanged throughout the hospitalization. Further work up was unremarkable for secondary causes of arterial dissection. Anticoagulation was started and the patient was discharged.

Conclusions The pathophysiology of upper cranial nerve palsies associated with carotid artery dissection remains unclear. Some mechanisms have been proposed in the literature. Given that the intracavernous portion of the ICA was unaffected in this case, one of the possible theoretical mechanisms is that the expanded vessel wall could be compressing the vasa nervorum originating from the petrosal segment of the carotid artery. This case illustrates that spontaneous dissection of the ICA without extension to the cavernous portion may present with an isolated abducens palsy and should be considered in the differential diagnosis in the proper setting.

Authors/Disclosures
Keyvan Heshmati, MD PRESENTER	Dr. Heshmati has nothing to disclose.
Jorge L. Rodriguez Lee, MD (Yale School of Medicine)	Dr. Rodriguez Lee has nothing to disclose.
Nora Montealegre, MD	Dr. Montealegre has nothing to disclose.
Volodymyr Vulkanov, MD (Rutgers, The State University of New Jersey)	Dr. Vulkanov has nothing to disclose.

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