This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Koennecke, H.-C. Articles by Seyfert, S. Search for Related Content PubMed PubMed Citation Articles by Koennecke, H.-C. Articles by Seyfert, S. Pubmed/NCBI databases Medline Plus Health Information Brain Aneurysm Carotid Artery Disease

(Stroke. 1998;29:2653-2655.)
© 1998 American Heart Association, Inc.

Case Reports

Mydriatic Pupil as the Presenting Sign of Common Carotid Artery Dissection

H.-C. Koennecke, MD S. Seyfert, MD

From the Department of Neurology, Universitätsklinikum Benjamin Franklin, Freie Universität Berlin, Berlin, Germany.

Correspondence to Hans-Christian Koennecke, MD, Department of Neurology, Universitätsklinikum Benjamin Franklin, Hindenburgdamm 30, 12200 Berlin, Germany. E-mail drhcknro{at}zedat.fu-berlin.de

Abstract

Background—Ipsilateral mydriasis is known to accompany signs of cerebral ischemia in unilaterally compromised carotid blood flow. Mydriasis as the presenting sign of common carotid artery (CCA) dissection has not been reported thus far.

Case Description—We report the case of a patient who presented with a mydriatic pupil after intraoperative injury of the ipsilateral CCA. Mydriasis preceded complete third-nerve palsy and symptoms of cerebral ischemia for 12 hours. Cerebral angiography revealed occlusion of the CCA with slow collateral flow to the internal carotid artery and fetal origin of the posterior cerebral artery, suggesting a hemodynamic mechanism causing ischemia of the oculomotor nerve. Signs of cerebral ischemia and third-nerve palsy resolved completely after reconstructive surgery of the occluded vessel.

Conclusions—A mydriatic pupil may be the unusual first sign of compromised carotid blood flow and impending cerebral ischemia.

Key Words: carotid artery • dissection • mydriasis • oculomotor nerve paralysis

This article has been cited by other articles:

				R. Inzelberg, P. Nisipeanu, S.C. Blumen, I. Kovach, G.M. Groisman, and R.L. Carasso Transient unilateral mydriasis as the presenting sign of aortic and carotid dissection Neurology, December 26, 2000; 55(12): 1934 - 1935. [Full Text] [PDF]