Cranial Neuropathy Secondary to Carotid Artery Dissection: Clinical Features and Long-Term Outcomes

TL;DR

This study examines rare cranial neuropathy caused by carotid artery dissection, finding it is usually treatable with medication and has good outcomes.

Contribution

The paper provides a comprehensive analysis of CAD-related cranial neuropathy's clinical features and treatment outcomes.

Findings

The hypoglossal nerve (CN XII) was most commonly affected in CAD-related cranial neuropathy.

Most patients showed symptom improvement with antithrombotic therapy or endovascular intervention.

Endovascular treatment was rarely used and mainly for dissecting pseudoaneurysms.

Abstract

(1) Background: Cranial neuropathy is a commonly encountered condition with various underlying etiologies. While carotid artery dissection (CAD) is a well-recognized cause of ischemic stroke, CAD-related cranial neuropathy is rare and poorly characterized. We have conducted a comprehensive review of the published literature to better characterize its clinical course and outcomes. (2) Methods: We systematically reviewed the PubMed, CENTRAL, Ovid MEDLINE, and Embase literature for CAD-related cranial neuropathy. Data extracted included demographics, affected cranial nerves, symptoms, time course, diagnostic approach, and therapeutic interventions. (3) Results: From 635 screened studies, 97 met the inclusion criteria, yielding data on 108 patients with CAD- or dissecting pseudoaneurysm (dPSA)-related cranial neuropathy. The hypoglossal nerve (CN XII) was most commonly affected (76%), and the distal cervical internal carotid artery was the most frequently involved segment (89%). Most patients (90%) were treated with antithrombotic therapy which included either antiplatelets (47%) or anticoagulants (43%). Thirteen patients (12%) underwent endovascular intervention, nearly all with a diagnosed dPSA (mean size, 14.8 mm). Outcomes were favorable, with 94% experiencing symptom improvement. (4) Conclusions: Despite inherent limitations, our study demonstrates that CAD-related cranial neuropathy is typically a benign condition that has excellent outcomes with medical management. Endovascular treatment is rarely performed and is primarily reserved for cases involving diagnosed dPSA.

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