Lower cranial nerve palsias in the internal carotid artery dissection

Abstract

We describe a 53 year old patient with the left internal carotid artery (ICA) dissection, which developed after the resection of tortuous part of ICA. The first clinical manifestations of dissection were the left lower cranial nerve palsies (dysphagia, dysphonia, disorder of tongue movement), in two days left frontotemporal headache appeared and in two weeks patient developed ischemic stroke in the territory of the left middle cerebral artery. Diagnosis of ICA dissection was confirmed by CT-angiography and duplex ultrasound. Morphological study of resected ICA found two small arteries beginning from ICA, small aneurismatic dilatation of the ICA wall and evidence of fibromuscular dysplasia. In two months, swallowing significantly improved and right hemiparesis partly regressed. Clinical and morphological data suggest that fibromuscular dysplasia was the cause of dissection and ischemia of the lower cranial nerves was the cause of their palsies. Blood supply of the lower cranial nerves was not from the external carotid artery, as usually, but from the ICA. Its dissection led to the interruption of the nutrient arteries and as the result – to nerve ischemia.