Ipsilateral Pupillary Dilation Following Carotid Endarterectomy: A Temporary and Benign Phenomenon. Issue 5 (6th April 2017)

• Record Type: Journal Article
• Authors: Steinberg, Jeffrey A.; Carter, Bob S.; Lee, Marco B.; Steinberg, Gary K.
• Is Part Of: Neurosurgery. Volume 80:Issue 5(2017)
• Page Start: E239
• Page End: E244
• Publication Date: 2017-04-06
• Subjects: Carotid endarterectomy -- Mydriasis -- Nerve ischemia; Nervous system -- Surgery -- Periodicals; 617.48005
• DOI: 10.1093/neuros/nyx051
• Languages: English
• ISSNs: 0148-396X

Abstract

Abstract: BACKGROUND AND IMPORTANCE: Cases of post carotid endarterectomy (CEA) Horner's syndrome have been reported, with symptoms attributed to manipulation of the sympathetic plexus situated along the carotid artery; however, these patients presented with the typical constricted pupil. We report the first 3 cases to our knowledge of mydriasis following CEA. CLINICAL PRESENTATION: We present 3 cases of CEA followed by immediate postoperative development of ipsilateral mydriasis. The patients were otherwise at their neurologic baseline and the mydriasis resolved over the ensuing few days. CONCLUSION: We suggest that these cases are secondary to an ischemic phenomenon, specifically to parasympathetic structures such as the ciliary ganglion and/or oculomotor nerve, resulting in autonomic dysfunction manifested by pupillary dilation. A similar finding of mydriasis occurring subsequent to other carotid pathology has been reported, with ischemia to parasympathetic structures also proposed as the underlying etiology. Although pupillary dilation often represents a worrisome neurosurgical sign indicating herniation, it should be recognized that after CEA this finding may be a transient, benign occurrence.