Internal Carotid Artery Dissection Causing Lower Cranial Neuropathies

As a recognised cause of acute stroke, particularly in younger patients, spontaneous carotid artery dissection is an important diagnosis to consider. Although advances in interventional radiology are improving diagnosis, it is still considered an underrecognised phenomenon [1]. It is estimated to account for around 2.5% of all strokes, but this figure is much higher for younger patients [2]. However, the clinical presentation can be varied, subtle and often challenging to make, with multiple different presentations described. Unilateral cranial nerve palsies, particularly of the lower cranial nerves, are a recognised sign in up to 12% of cervical artery dissections [1], and it is therefore vital to be able to recognise them. We present a case of a man referred to a head and neck cancer clinic with unilateral lower cranial neuropathies and neck pain who was subsequently found to have an internal carotid artery dissection.

Keywords: Cranial nerves; Carotid artery dissection; Stroke

Abbreviations: MRI: Magnetic Resonance Imaging; CTA: Computed Tomography Angiography