■本研究旨在强调脑神经(CN)麻痹在自发性颈动脉夹层(sCeAD)中的重要性。
■对“颈动脉夹层”和“颅神经麻痹”进行了基于搜索词的文献综述。“在2023年10月之前发表的英文和德文文章被考虑在内。
■sCeAD的颅神经(CN)麻痹在大约10%的病例中很明显。在文学中,孤立的CNII麻痹,III,VII,IX,X,和十二已被报道,而CNXI麻痹仅与其他下颅神经麻痹合并发生。夹层类型和壁血肿定位特定于受影响的CN,因为II或III的CN麻痹仅在位于ICA更近端节段的狭窄闭塞血管病变中明显。而那些患有九世CN麻痹的人,X,XI,和XII发生在更远端的扩张性sCeAD中。这种二分法强调了与sCeAD相关的CN麻痹的不同病理机制的假设,一种是低灌注或微栓塞(CNII,III,和VII),另一种是对周围组织的局部质量影响(CNIX,X,XI,和XII)。临床上,周围性麻痹和脑干梗死引起的麻痹很难区分。这种区别是关键,as,根据审查的案件,sCeAD患者的周围颅神经麻痹大多随时间完全消退,而那些由于脑干中风而没有,使脑血管影像评估必不可少。
■重要的是要将夹层视为周围CN麻痹的潜在原因,并意识到适当的诊断途径。这种意识可以帮助临床医生做出早期诊断,提供一级预防中风的机会。
UNASSIGNED: This study aimed to emphasize the importance of cranial nerve (CN) palsies in spontaneous cervical artery dissection (sCeAD).
UNASSIGNED: A search term-based literature review was conducted on \"cervical artery dissection\" and \"cranial nerve palsy.\" English and German articles published until October 2023 were considered.
UNASSIGNED: Cranial nerve (CN) palsy in sCeAD is evident in approximately 10% of cases. In the literature, isolated palsies of CN II, III, VII, IX, X, and XII have been reported, while CN XI palsy only occurs in combination with other lower cranial nerve palsies. Dissection type and mural hematoma localization are specific to affected CN as CN palsies of II or III are solely evident in those with steno-occlusive vessel pathologies located at more proximal segments of ICA, while those with CN palsies of IX, X, XI, and XII occur in expansive sCeAD at more distal segments. This dichotomization emphasizes the hypothesis of a different pathomechanism in CN palsy associated with sCeAD, one being hypoperfusion or microembolism (CN II, III, and VII) and the other being a local mass effect on surrounding tissue (CN IX, X, XI, and XII). Clinically, the distinction between peripheral palsies and those caused by brainstem infarction is difficult. This differentiation is key, as, according to the reviewed cases, peripheral cranial nerve palsies in sCeAD patients mostly resolve completely over time, while those due to brainstem stroke do not, making cerebrovascular imaging appraisal essential.
UNASSIGNED: It is important to consider dissections as a potential cause of peripheral CN palsies and to be aware of the appropriate diagnostic pathways. This awareness can help clinicians make an early diagnosis, offering the opportunity for primary stroke prevention.