Abstract
ObjectivesTo present a rare case of unilateral vocal cord paralysis (VCP) secondary to spontaneous internal carotid artery dissection and to perform a literature review.Case reportA 35-year-old male presented to the emergency department with acute onset hoarseness and dysphagia. History, physical exam and laryngoscopy revealed left sided VCP without obvious cause. Magnetic Resonance Imaging (MRI) demonstrated a left internal carotid artery dissection of unknown etiology. Neurovascular surgery was consulted and treatment with aspirin was initiated. The dysphagia and hoarseness resolved in 12 weeks with long-term neurosurgery follow-up as the management plan.MethodsSystematic literature review was conducted by 3 independent reviewers. Since 1988 only 9 cases of VCP due to internal carotid artery dissection have been reported. These were reviewed for: demographics, diagnostic method, treatment and vocal cord function.Results7 patients had unilateral while 2 had bilateral VCP. MRI was used for diagnosis in 7 cases and 5 cases utilized a type of angiography. All received antithrombotic treatment with 5 out of the 9 patients experiencing vocal cord recovery in an average of 7.2 weeks.ConclusionMRI is crucial in the work-up of idiopathic VCP. If an ipsilateral internal carotid artery dissection is found, antithrombotic treatment is initiated with an expectation that vocal cord mobility is likely to return.
Highlights
If an ipsilateral internal carotid artery dissection is found, antithrombotic treatment is initiated with an expectation that vocal cord mobility is likely to return
Spontaneous internal carotid artery dissection is a rare cause of lower cranial nerve palsy, which often leads to vocal cord paralysis (VCP)
Conclusion rare, ICA dissection should be considered in the differential diagnosis of potentially idiopathic VCP
Summary
Spontaneous internal carotid artery dissection is a rare cause of lower cranial nerve palsy, which often leads to vocal cord paralysis (VCP). More common causes include infiltrating skull base tumours, trauma or inflammatory disease [1]. The incidence of internal carotid artery dissection ranges from 2.5 to 3 per 100 000 [2] affecting mostly men in their fifties [3]. The first reported case of spontaneous ICA was in 1959 [4]. Few cases associated with lower cranial nerve palsies have been described. A VCP secondary to an internal carotid artery dissection is described and a systematic review of the literature is performed.
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