Multiple Lower Cranial Neuropathies Following Carotid Endarterectomy

This is a patient who underwent a right carotid endarterectomy (CEA). Following the surgery, multiple right sided lower cranial nerves were involved. In his case, there was trapezius and sternocleidomastoid weakness and atrophy on the right, indicative of right CN XI injury. There was an absent gag reflex on the right, indicative of right CN IX injury. There was palatal weakness on the right with deviation of the palate/uvula to the left, indicative of right CN X injury. Finally, there was atrophy of the right side of the tongue with rightward tongue deviation with protrusion, indicative of right CN XII injury. Mechanisms for cranial nerve injury associated with CEA include stretch, retraction, or clamping-related trauma or cutting of the nerve itself. The combination of CN IX, X, XI and XII is known as the Collet-Sicard syndrome, and localizes to the retroparotid space. [[Number of Videos and legend for each: 1, patient with paresis of cranial nerves IX, X, XI, and XII on the right.]