Females are affected more and the age of onset is usually between 10 and 40 years. Takayasu arteritis is a rare, chronic large vessel vasculitis involving the aorta and its primary branches. In cases of internal carotid artery dissection, vasculitis such as Takayasu arteritis should also be considered. This case report illustrates that internal carotid artery dissection should be a differential diagnosis in palsies of the third, fourth, or sixth cranial nerves, especially when associated with headache. Internal carotid artery dissection within the cavernous sinus can lead to third, fourth and sixth nerve palsy due to compression, stretching and ischemia from occlusion of the nutritional arteries. She was started on aspirin and high dose steroids. Takayasu arteritis was diagnosed subsequently. She also had stenosis and aneurysmal dilatation of right subclavian artery. On imaging, dissection and dilatation was evident in the right internal carotid artery from the origin up to the cavernous segment. Case presentationĪ 38-year-old Sri Lankan female presented with sudden onset severe headache, fixed dilated pupil, complete ptosis and ophthalmoplegia on the right side. This is the first case report of Takayasu arteritis presenting as complete ophthalmoplegia due to internal carotid artery dissection. Internal carotid artery dissection in Takayasu arteritis is very rare and complete ophthalmoplegia due to internal carotid artery dissection is also rare. Neurological sequelae of intracranial arterial dissection results from cerebral ischemia due to thromboembolism and hypo perfusion. Arterial dissection is due to separation of the layers of the arterial wall resulting in a false lumen, where blood seeps into the vessel wall. As the disease progresses, the active inflammation of large vessels leads to dilation, narrowing and occlusion of the arteries. University of Iowa Health Care Eye Rounds 2018.Takayasu arteritis is a rare, chronic large vessel vasculitis involving the aorta and its primary branches. Self-resolving ischemic third nerve palsy. Canady FJ, Ricca AM, Stiff HA, Shriver EM, et al.Imaging of oculomotor (third) cranial nerve palsy. Down and out: acquired oculomotor nerve palsy. Singh RB, Shergill S, Singh KP, Thakur S.Acquired oculomotor nerve palsy, EyeWiki. Risk factors for ischemic ocular motor nerve palsies. Relative pupil-sparing third nerve palsy: etiology and clinical variables predictive of a mass. The aetiologies of the unilateral oculomotor nerve palsy: a review of the literature. Raza HK, Chen H, Chansysouphanthong T, Cui G.Lesions within the cavernous sinus, superior orbital fissure, or the orbit: These areas can produce an isolated palsy, but they most commonly involve other cranial nerve dysfunctions, proptosis, and/or visual loss.The subarachnoid space is often imaged to rule out a compressive aneurysm near the posterior communicating artery. Lesions within the subarachnoid space: This is the highest area of interest as these lesions can produce pupillary involvement.Lesions within the oculomotor nerve fascicles: This can produce several manifestations, including isolated dysfunction of the superior or inferior division only.Lateral subnuclei innervates ipsilateral IR, IO, and MR muscles.Medial subnuclei innervates contralateral SR muscle.Central subnucleus innervates bilateral levator palpebrae superioris muscles.This is because the oculomotor nerve has multiple subnuclei, and some of those innervate the contralateral eye: Lesions within the midbrain: Often produces bilateral results.The manifestations of the palsy may depend on the location of the lesion along the pathway.
The oculomotor nerve travels a long path from the midbrain to the EOM muscles.
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