title: Detection of inferolateral trunk syndrome by neuromonitoring during catheter angiography with provocative testing.
abstract: BACKGROUND
  It is not uncommon that endovascular balloon test occlusion (BTO) is performed to assess collateral blood flow and risk of injury of permanent occlusion of the internal carotid artery (ICA). This case is the first reported of detection and reversal of the inferolateral trunk (ILT) syndrome in an awake patient during provocative BTO; prompt recognition of the syndrome effectively prevented permanent neurologic deficits.
  
  
  METHODS
  The case of a 42-year-old woman is reported who had a left sphenoid wing meningioma with extension into the cavernous sinus and who underwent awake catheter angiography with provocative BTO of the ICA. Serial examinations by intraoperative monitoring neurologists and neurointerventionalists detected acute progressive left retro-orbital pressure followed by sudden inability to adduct the left eye, or a left medial rectus palsy, indicative of the ILT syndrome which led to immediate balloon deflation and resolution of the deficits. The hypothesis was that hypoperfusion of the ILT, an arterial branch of the ICA which provides blood supply to several cranial nerves (CN) III, CN V1 and CN V2, caused her acute symptoms.
  
  
  CONCLUSIONS
  Although cerebral ischemia is a well known complication of endovascular procedures, CN ischemia is a rare potential risk. Knowledge of cerebrovascular anatomy and serial examinations prevented neurologic deficits; this case underscores the added utility of examinations by intraoperative monitoring neurologists and interdisciplinary collaboration.
authors.affiliation: Department of Neurology and Intraoperative Neuromonitoring, Stanford University Medical Center, Stanford, California 94305, USA. schele@stanford.edu
authors.forename: Scheherazade
authors.initials: S
authors.lastname: Le
authors.forename: Robert
authors.initials: R
authors.lastname: Dodd
authors.forename: Jaime
authors.initials: J
authors.lastname: López
authors.forename: Viet
authors.initials: V
authors.lastname: Nguyen
authors.forename: S Charles
authors.initials: SC
authors.lastname: Cho
authors.forename: Leslie
authors.initials: L
authors.lastname: Lee
mesh_terms: D000328:Adult; D021721:Balloon Occlusion / Q000379:methods*; D002340:Carotid Artery Diseases / Q000150:complications / Q000000981:diagnostic imaging*; D002404:Catheterization / Q000379:methods*; D002533:Cerebral Angiography; D005260:Female; D006801:Humans; D008577:Meningeal Neoplasms / Q000150:complications / Q000000981:diagnostic imaging*; D008579:Meningioma / Q000150:complications / Q000000981:diagnostic imaging*; D013577:Syndrome