Regional subacute cranial neuropathies following internal carotid cisplatin infusion

The inferolateral trunk arises from the internal carotid artery at C-4 and provides vascular supply to cranial nerves III to VI. We report a patient who developed neuropathies of cranial nerves III, V_1-3, and VI, 48 hours after infusion of cisplatin into the right internal carotid artery for an anaplastic oligoastrocytoma. The clinical and radiographic findings implicated direct toxicity to nerves in the distribution of the inferolateral trunk. We found additional cases by review of published brain tumor chemotherapy trials, thus identifying a novel, toxic neurovascular mechanism for injury to cranial nerves III to VI.