An unusual presentation of dysarthria in a young patient, a stroke mimic

Internal carotid artery dissection commonly affects younger patients. We present a case of a previously fit and well 43-year-old gentleman who presented with a sudden onset of slurring of speech, with right-sided tongue deviation and fasciculation on examination. Signs and symptoms began following participation in a home workout class. Magnetic resonance angiography revealed right-sided extracrainal internal carotid artery dissection leading to right-sided unilateral twelfth cranial nerve palsy.

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Teaching NeuroImages: Isolated hypoglossal nerve palsy due to internal carotid artery dissection

Neurology ◽

10.1212/wnl.0b013e3182604506 ◽

2012 ◽

Vol 79 (4) ◽

pp. e37-e37 ◽

Cited By ~ 8

Author(s):

T. Okunomiya ◽

T. Kageyama ◽

T. Suenaga

Keyword(s):

Carotid Artery ◽

Internal Carotid Artery ◽

Nerve Palsy ◽

Internal Carotid ◽

Hypoglossal Nerve ◽

Carotid Artery Dissection ◽

Artery Dissection ◽

Internal Carotid Artery Dissection ◽

Hypoglossal Nerve Palsy

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Isolated oculomotor nerve palsy inspontaneous internal carotid artery dissection: case report

Arquivos de Neuro-Psiquiatria ◽

10.1590/s0004-282x2003000400027 ◽

2003 ◽

Vol 61 (3A) ◽

pp. 668-670 ◽

Cited By ~ 8

Author(s):

Cynthia Resende Campos ◽

Ayrton Roberto Massaro ◽

Milberto Scaff

Keyword(s):

Carotid Artery ◽

Internal Carotid Artery ◽

Nerve Palsy ◽

Internal Carotid ◽

Carotid Artery Dissection ◽

Oculomotor Nerve ◽

Oculomotor Nerve Palsy ◽

Artery Dissection ◽

Internal Carotid Artery Dissection ◽

The Third

Partial oculosympathetic palsy followed by ischemic manifestations in brain or retina are the main symptoms of extracranial internal carotid artery (ICA) dissection. Unusually, cranial nerves may be affected. Isolated oculomotor nerve palsy is found only rarely. CASE: We present a 50-year-old nondiabetic man who experienced acute onset of right occipital headache which spread to the right retro-orbital region. Five days later he noticed diplopia and right blurred vision sensation. Neurologic examination disclosed only impaired adduction and upward gaze of right eye, slight ipsilateral pupillary dilatation, without ptosis. Brain MRI was normal. Angiography showed right internal carotid artery dissection with forward occlusion to the base of the skull. Intravenous heparin followed by warfarin was prescribed. The headache and the oculomotor nerve deficit gradually resolved in the next three weeks. DISCUSSION: Isolated oculomotor nerve palsy is underrecognized as a clinical presentation of extracranial ICA dissection. If the angiographic evaluation is incomplete without careful study of extracranial arteries, misdiagnosis may lead to failure to initiate early treatment to prevent thromboembolic complications. For this reason we draw attention to the need for careful evaluation of cervical arteries in patients with oculomotor nerve palsy. Mechanical compression or stretching of the third nerve are possible mechanisms, but the direct impairment of the blood supply to the third nerve seems to be the most plausible explanation.

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Internal Carotid Artery dissection presenting as Isolated Hypoglossal nerve palsy

Acute Medicine Journal ◽

10.52964/amja.0226 ◽

2009 ◽

Vol 8 (1) ◽

pp. 22-25

Author(s):

Amir Ahmad ◽

◽

Amir Ahmad ◽

Philip Travis ◽

Mark Doran ◽

...

Keyword(s):

Carotid Artery ◽

Internal Carotid Artery ◽

Cranial Nerve ◽

Nerve Palsy ◽

Internal Carotid ◽

Cranial Nerves ◽

Carotid Artery Dissection ◽

Artery Dissection ◽

Internal Carotid Artery Dissection ◽

Cranial Nerve Palsies

Internal carotid dissection most commonly presents as headache, focal neurological deficits or stroke. Rarely it can manifest itself by causing a palsy of the lower cranial nerves (IX, X, XI, XII). The reported incidence of isolated cranial nerve palsies is rare. We report a case of an internal carotid artery dissection manifesting as isolated XII (hypoglossal) cranial nerve palsy.

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Isolated hypoglossal nerve palsy from internal carotid artery dissection related to PKD-1 gene mutation

BMC Neurology ◽

10.1186/s12883-019-1477-1 ◽

2019 ◽

Vol 19 (1) ◽

Author(s):

Zhaoyao Chen ◽

Jun Yuan ◽

Hui Li ◽

Cuiping Yuan ◽

Kailin Yin ◽

...

Keyword(s):

Carotid Artery ◽

Internal Carotid Artery ◽

Nerve Palsy ◽

Internal Carotid ◽

Hypoglossal Nerve ◽

Carotid Artery Dissection ◽

Artery Dissection ◽

Internal Carotid Artery Dissection ◽

Hypoglossal Nerve Palsy ◽

High Resolution Mri

Abstract Background Internal carotid artery dissection has been well recognized as a major cause of ischaemic stroke in young and middle-aged adults. However, internal carotid artery dissection induced hypoglossal nerve palsy has been seldom reported and may be difficult to diagnose in time for treatment; even angiography sometimes misses potential dissection, especially when obvious lumen geometry changing is absent. Case presentation We report a 42-year-old man who presented with isolated hypoglossal nerve palsy. High-resolution MRI showed the aetiological dissected internal carotid artery. In addition, a potential genetic structural defect of the arterial wall was suggested due to an exon region mutation in the polycystic-kidney-disease type 1 gene. Conclusions Hypoglossal nerve palsy is a rare manifestations of carotid dissection. High-resolution MRI may provide useful information about the vascular wall to assist in the diagnosis of dissection. High-throughput sequencing might be useful to identify potential cerebrovascular-related gene mutation, especially in young individuals with an undetermined aetiology.

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