1/121. Internuclear ophthalmoplegia after coronary artery catheterization and percutaneous transluminal coronary balloon angioplasty.A retrospective chart review was performed for identification of patients with isolated internuclear ophthalmoplegia (INO) postcardiac catheterization from two neuro-ophthalmology units. Of the 110 patients with a diagnosis of INO who were evaluated during the observation period, five patients (4.5%) demonstrated relatively isolated INO occurring in the perioperative period of a cardiac endovascular procedure. These five patients underwent diagnostic catheterization alone (three patients), balloon angioplasty (one patient), or stent placement (one patient). All patients improved, with resolution of diplopia in primary position after a mean period of 82 days. The occurrence of INO in the postcardiac catheterization setting is not uncommon, and it appears to be related to dorsal pontine ischemia. The pontomesencephalic medial longitudinal fasciculus is supplied by small-caliber perforating end-arteries from the basilar trunk, which increases selective vulnerability of this area. cardiac catheterization may precipitate microemboli involving these vessels, leading to internuclear ophthalmoplegia.- - - - - - - - - - ranking = 1keywords = artery (Clic here for more details about this article) |
2/121. Temporary uniocular blindness and ophthalmoplegia associated with a mandibular block injection. A case report.A mandibular block injection produced temporary uniocular blindness, total ophthalmoplegia, mydriasis, and ptosis of the eyelid, with diplopia developing as the sight returned. These effects lasted 25-30 minutes. The explanation offered as to the cause of the anaesthetic phenomenon is an intra-arterial injection into the maxillary artery with backflow of anaesthetic solution into the middle meningeal artery. The instantaneous blindness results from the anaesthetic agent being carried into the central artery of the retina through an anastomosis of the ophthalmic and middle meningeal arteries via the recurrent meningeal branch of the lacrimal artery. Although of short duration, the symptoms mimic a more serious carotid artery embolus occluding the ophthalmic artery. Complications of mandibular blocks have been reported in the literature, however total blindness and ophthalmoplegia are extremely rare. This case report highlights an event where individual anatomical variation of the maxillary and middle meningeal arteries has allowed anaesthetic solution to be delivered to an ectopic site.- - - - - - - - - - ranking = 10.769212038292keywords = carotid artery, carotid, artery (Clic here for more details about this article) |
3/121. Painful fourth cranial nerve palsy caused by posteriorly-draining dural carotid-cavernous sinus fistula.A 65-year-old man with a dural carotid-cavernous fistula (DCCF) presented with sudden onset of painful trochlear nerve paresis. Typical signs of DCCF including conjunctival arterialization, chemosis, and proptosis did not become manifest until 4 months later. This unusual presentation of DCCF was caused by drainage of the fistula posteriorly into the inferior petrosal sinus with low flow. With this condition, patients may present with trochlear nerve palsy without a red eye. Although rare, DCCF must be considered in patients presenting with isolated painful trochlear palsy.- - - - - - - - - - ranking = 22.96484723652keywords = carotid (Clic here for more details about this article) |
4/121. ophthalmoplegia resulting from an intraorbital hematoma.BACKGROUND: A case is described in which an intraorbital hematoma was found to complicate recovery from attempted aneurysm clipping 5 days into the postoperative period. The etiology, management, and complication avoidance are discussed. CASE DESCRIPTION: Five days after attempted surgical clipping of an internal carotid artery aneurysm via a frontotemporal craniotomy with orbital osteotomy, a patient underwent coiling of the aneurysm. Shortly after the endovascular procedure, the patient developed exophthalmos and ophthalmoplegia involving the right side followed by decline in her level of consciousness. An emergency computed tomography (CT) scan revealed an epidural hematoma with intraorbital extension. After evacuation of the hematoma, the patient recovered extraocular function and returned to her baseline mental status. CONCLUSION: exophthalmos and ophthalmoplegia in a patient recovering from cranial surgery using skull base techniques warrants immediate attention, especially after endovascular procedures. Delay in intervention may result in loss of neurologic function or life. The authors discuss the relevant literature and management of this uncommon complication.- - - - - - - - - - ranking = 9.5192120382919keywords = carotid artery, carotid, artery (Clic here for more details about this article) |
5/121. Painful ophthalmoplegia with reversible carotid stenosis in a child.Painful ophthalmoplegia in childhood has different causes. One is tolosa-hunt syndrome, in which a first episode may be difficult to diagnose because of its clinical similarity to ophthalmoplegic migraine. A 10-year-old male with painful ophthalmoplegia and a cavernous sinus inflammation associated with an intracavernous carotid stenosis demonstrated by magnetic resonance imaging and angiography is reported. These findings resolved in follow-up imaging. This report suggests that in the presence of painful ophthalmoplegia, magnetic resonance imaging detection of cavernous sinus inflammation can facilitate the diagnosis of tolosa-hunt syndrome when other causes are excluded.- - - - - - - - - - ranking = 22.96484723652keywords = carotid (Clic here for more details about this article) |
6/121. Carotid cavernous fistula due to a ruptured intracavernous aneurysm of the internal carotid artery: treatment with selective endovascular occlusion of the aneurysm.Intracavernous carotid artery aneurysms causing a carotid-cavernous fistula (CCF) are rare. These aneurysms usually cause neurological symptoms due to gradual expansion without rupture. If they do rupture they most often lead to a CCF instead of bleeding into the subarachnoid space. A patient is described with a ruptured intracavernous aneurysm causing a CCF resulting in acute onset of unilateral ophthalmoplegia. Selective coil embolisation of the aneurysm led to complete occlusion of the CCF with preservation of the internal carotid artery; symptoms resolved completely.- - - - - - - - - - ranking = 61.708241677056keywords = carotid artery, carotid, artery (Clic here for more details about this article) |
7/121. Painful ophthalmoplegia: report of a case with cerebral involvement and psychiatric complications.The diagnosis of tolosa-hunt syndrome should be suspected in the presence of recurrent "painful ophthalmoplegia." The most useful tests are the rapid (within 48 hours) response to steroids and positive findings on orbital venography. It should be emphasized that Tolosa-Hunt's syndrome may not be a "pure syndrome." Perhaps it is only an occasional presentation of another rather poorly understood syndrome, that of "recurrent cranial neuropathies." The present patient had at least three episodes of painful ophthalmoplegia prior to this hospitalization. During the last hospitalization, he presented with painful ophthalmoplegia, showed a rapid response to steroids, had narrowing of the carotid artery on arteriogram and an abnormal orbital venogram. However, during his hospitalization he developed involvement of cranial nerves II, III, V, VI and VII, papilledema, pyramidal tract signs and severe psychiatric disturbances, all of which remitted. This, coupled with the abnormal pneumoencephalogram and electroencephalogram and organicity on psychological testing, suggests cerebral involvement in our case.- - - - - - - - - - ranking = 9.5192120382919keywords = carotid artery, carotid, artery (Clic here for more details about this article) |
8/121. Pseudomyasthenia resulting from a posterior carotid artery wall aneurysm: a novel presentation: case report.OBJECTIVE AND IMPORTANCE: Painful oculomotor palsy can result from enlargement or rupture of intracranial aneurysms. The IIIrd cranial nerve dysfunction in this setting, whether partial or complete, is usually fixed or progressive and is sometimes reversible with surgery. We report an unusual oculomotor manifestation of a posterior carotid artery wall aneurysm, which mimicked ocular myasthenia gravis. CLINICAL PRESENTATION: A 47-year-old woman developed painless, intermittent, partial IIIrd cranial nerve palsy. She presented with isolated episodic left-sided ptosis, which initially suggested a metabolic or neuromuscular disorder. However, digital subtraction angiography revealed a left posterior carotid artery wall aneurysm, just proximal to the origin of the posterior communicating artery. INTERVENTION: The aneurysm was successfully clipped via a pterional craniotomy. During surgery, the aneurysm was observed to be compressing the oculomotor nerve. The patient's symptoms resolved after the operation. CONCLUSION: The variability of incomplete IIIrd cranial nerve deficits can present a diagnostic challenge, and the approach for patients with isolated IIIrd cranial nerve palsies remains controversial. Although intracranial aneurysms compressing the oculomotor nerve classically produce fixed or progressive IIIrd cranial nerve palsies with pupillary involvement, anatomic variations may result in atypical presentations. With the exception of patients who present with pupil-sparing but otherwise complete IIIrd cranial nerve palsy, clinicians should always consider an intracranial aneurysm when confronted with even subtle dysfunction of the oculomotor nerve.- - - - - - - - - - ranking = 57.365272229752keywords = carotid artery, carotid, artery (Clic here for more details about this article) |
9/121. dissection of the intracranial internal carotid artery producing isolated oculomotor nerve palsy with sparing of pupil.dissection of the internal carotid artery usually occurs in the cervical segment, but rarely may involve the artery in the intracranial course (1). The clinical course of intracranial dissection is often catastrophic, with rapid onset of profound neurological deficit, as a result of middle and/or anterior cerebral artery involvement. When this occurs the mortality rate is generally considered high. We describe a case of intracranial internal carotid artery dissection following trivial trauma presented with an isolated painful pupillary sparing oculomotor nerve palsy.- - - - - - - - - - ranking = 57.615272229752keywords = carotid artery, carotid, artery (Clic here for more details about this article) |
10/121. Posttraumatic carotid-cavernous sinus fistula.BACKGROUND AND OBJECTIVES: Posttraumatic carotid-cavernous sinus fistula is a rare complication of maxillofacial trauma and is seldom discussed in the literature. Motor vehicle accidents, falls, and other crush injuries contribute to the incidence of basilar skull fractures and the formation of fistulae. When injuries occur in the vessel wall, the carotid artery has the potential to fill the low-pressure cavernous sinus. The symptoms include chemosis, proptosis, pulsating exophthalmos, diplopia, ophthalmoplegia, orbital pain, audible bruits, and blindness. methods AND MATERIALS: The conventional treatments include carotid ligation and embolization. These techniques have often proved to be ineffective. A new method--the occlusive balloon technique--has been developed and is described in this article. A clinical case is used to illustrate the procedure. RESULTS AND/OR CONCLUSIONS: Utilization of balloon catheters provides a minimally invasive technique to treat patients, without significant morbidity or mortality. The procedure is found to be successful and predictable.- - - - - - - - - - ranking = 37.077028722116keywords = carotid artery, carotid, artery (Clic here for more details about this article) |
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