title: Third nerve palsy following carotid artery dissection and posterior cerebral artery thrombectomy: Case report and review of the literature.
abstract: BACKGROUND
  Common causes of oculomotor nerve palsy are diabetes, aneurysmal compression, and uncal herniation. A lesser-known cause of third nerve dysfunction is ischemia, often due to carotid artery dissection.
  
  
  METHODS
  An 80-year-old man presented with an acute ischemic stroke with a National Institutes of Health Stroke Scale score of >20 from a high cervical internal carotid artery (ICA) dissection and a tandem ICA terminus embolic occlusion with extension of clot into the adjacent fetal posterior cerebral artery (PCA). We used a stentriever to perform selective PCA thrombectomy, with immediate postthrombectomy development of ipsilateral anisocoria. The anisocoria progressed into complete oculomotor nerve palsy over 8 h after the procedure.
  
  
  CONCLUSIONS
  The clinical course described in this case is consistent with injury to the third nerve due to mechanical injury or occlusion of perforator supply to the nerve during thrombectomy. Oculomotor nerve palsy is a rare but known complication after ischemia; however, to our knowledge, this is the first case after thrombectomy for a PCA embolus.
authors.affiliation: Department of Neurosurgery, School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, USA ; Department of Neurosurgery, Gates Vascular Institute-Kaleida Health, New York, USA.
authors.forename: Michael
authors.initials: M
authors.lastname: Kogan
authors.affiliation: Department of Neurosurgery, School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, USA ; Department of Neurosurgery, Gates Vascular Institute-Kaleida Health, New York, USA.
authors.forename: Sabareesh K
authors.initials: SK
authors.lastname: Natarajan
authors.affiliation: Department of Neurology, School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, USA ; Department of Neurology, Gates Vascular Institute-Kaleida Health, Buffalo, New York, USA.
authors.forename: Nina
authors.initials: N
authors.lastname: Kim
authors.affiliation: Department of Neurology, School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, USA ; Department of Neurology, Gates Vascular Institute-Kaleida Health, Buffalo, New York, USA.
authors.forename: Robert N
authors.initials: RN
authors.lastname: Sawyer
authors.affiliation: Department of Neurosurgery, School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, USA ; Department of Neurology, School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, USA ; Department of Radiology, School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, USA ; Toshiba Stroke and Vascular Research Center, University at Buffalo, State University of New York, USA ; Department of Neurosurgery, Gates Vascular Institute-Kaleida Health, New York, USA.
authors.forename: Kenneth V
authors.initials: KV
authors.lastname: Snyder
authors.affiliation: Department of Neurosurgery, School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, USA ; Department of Radiology, School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, USA ; Department of Neurosurgery, Gates Vascular Institute-Kaleida Health, New York, USA ; Jacobs Institute, Buffalo, New York, USA.
authors.forename: Adnan H
authors.initials: AH
authors.lastname: Siddiqui
keywords: Carotid artery dissection; mechanical thrombectomy; oculomotor nerve palsy; stroke; third cranial nerve palsy