Posterior Palsy

The presence of cranial neuropathy may result in a misdiagnosis of brainstem stroke. Cranial nerve palsies may result from local pressure from the false internal carotid artery lumen, thromboembolism or hemodynamic compromise to the blood supply of the nerve. Cranial nerve III receives its blood supply from the ophthalmic artery, branches of the internal carotid or the posterior cerebral artery and, consequently, may rarely become ischemic after carotid dissection. 

Unruptured aneurysms not associated with SAH should normally be clipped or coiled if they are symptomatic, for instance if there is a third nerve palsy caused by a posterior communicating artery aneurysm (Fig. 30.2) (Raps et al. 1993). The optimal management of incidental unruptured asymptomatic aneurysms is unclear because the risk of rupture is... 

Chemoneurectomy with aqueous phenol injection in 116 selected patients with spastic cerebral palsy, in whom 246 peripheral nerves were blocked, caused complications in 11 patients (28). Five patients, in whom the posterior tibial nerve was blocked, developed paresthesia one had complete loss of sensation, which recovered spontaneously after a couple of days and three had pain at the site of injection or in the distribution of the injected nerve, lasting for a few days to a month. In another study there was a 3% complication rate in 98 blocks (29), while adverse effects occurred in nine of 150 blocks, with muscle weakness in eight cases and painful paresthesia in one (30). 

Fig. 5.16. a Giant ICA aneurysm inducing optic nerve compression in a 10-year-old boy with visual deficit on the right eye. b Brain stem aneurysm between origin of the superior cerebellar artery and posterior cerebral artery resulting in right sided oculomotor palsy. c,d Pcom aneurysm (c DSA, lateral view) in a 46-year-old-patient with oculomotor palsy note the close relationship of the aneurysm and the oculomotor nerve (arrow) but without visible contact (d, sagittal reconstruction of CISS sequence)... 

Perneczky A, Czech T (1984) Prognosis of oculomotor palsy following subarachnoid hemorrhage due to aneurysms of the posterior communicating artery. Zentralbl Neurochir 45 189-195... 

In a retrospective clinical and radio-graphic review of complications related to intrathecal baclofen and posterior spine fusion in patients with cerebral palsy, the dosage of baclofen did not increase despite the operation [45 ]. 

Hunter JD, Franklin K, Hughes PM (1998) The ultrasound diagnosis of posterior shoulder dislocation associated with Erb s palsy. Pediatr Radiol 28 510-511 Hurley ME, Keye GD, Hamilton S (2004) Is ultrasound really helpful in the detection of rib fractures Injury 35 562-566... 

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