Internal-Carotid-Artery Dissection and Cranial-Nerve Palsies

Abstract

A 45-year-old woman presented to the emergency department 3 days after the acute onset of severe dysphagia, breathy dysphonia, and earache and pulsatile tinnitus in the left ear. Her medical history was unremarkable. Physical examination revealed leftward deviation of the protruded tongue that was consistent with a lesion in cranial nerve XII, hypernasal speech and rightward deviation of the soft palate on phonation that was consistent with lesions in cranial nerves IX and X, and a paralyzed left vocal cord detected on laryngoscopic examination that was consistent with a lesion in cranial nerve X (see video). Axial magnetic resonance images . . .