Surgical positicion, cause of extracranial internal carotid artery disection, presenting as pourfour du petit sundrome. case report and literature review

Abstract

Dissection of the internal carotid artery is a rare cause of stroke overall, but causes 22% of strokes in younger patients. A common clinical presentation is as Claude Bernard Horner syndrome. We report a craniotomy with 30 degrees rotation of the neck (standard position) in a patient with no major risk factors for carotid dissection, who showed a Pourfour du Petit syndrome due to a dissection of the internal carotid artery. To the best of our knowledge, this is the first reported case in which a common surgical position causes an internal carotid artery dissection in a patient without relevant risk factors. The presentation with Pourfour du Petit syndrome is extremely unusual. KeywoRds: Carotid dissection, Pourfour du Petit syndrome, Neck rotation ÖZİnternal karotid arter diseksiyonu genel olarak inmenin nadir bir nedenidir ama daha genç hastalarda inmelerin %22'sine neden olur. Sık görülen bir klinik sunum Claude Bernard Horner sendromudur. Karotid diseksiyon için majör risk faktörleri olmayan ve boynun 30 derece rotasyonuyla (standart pozisyon) kraniyotomi yapılan bir hastada internal karotid arter diseksiyonu nedeniyle Pourfour du Petit sendromu gelişmesini sunuyoruz. Bildiğimiz kadarıyla bu ilgili risk faktörleri olmayan bir hastada sık kullanılan bir cerrahi pozisyonun internal karotid arter diseksiyonuna neden olduğu ilk bildirilen olgudur. Pourfour du Petit sendromu ile birlikte durum son derece nadirdir.

Pourfour du Petit Syndrome Associated With Right Eye Pressure

“…PDP syndrome has been associated with various causes, each thought to somehow irritate and stimulate oculosympathetic nerve fibers ipsilaterally rather than inhibit the parasympathetics, although the exact mechanism is not known . Some of these lesions also have the potential to cause a Horner syndrome, and it is unclear why a similar lesion may cause sympathetic stimulation instead of oculosympathetic paresis.…”

Carotid artery blood flow changes associated with head positioning in patients undergoing thyroidectomy

“…Carotid artery occlusions and dissections are reported when careful measures are not taken to avoid excessive head rotation or neck extension. [ 2 ] There are possibilities of insufficiency in blood flow through carotid arteries during head positioning which is usually compensated by collateral circulation in normal conditions. This compensation may be hampered in patients with congenital abnormalities or diseases such as atherosclerosis.…”