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We report a 40-year-old man with dysphagia, right temporal pain, right pulsatile tinnitus, and dysphonia due to right vocal cord paralysis on laryngoscopy. Neurologic examination was notable only for decreased palate elevation on the right. MRI of the neck revealed a right internal carotid artery (ICA) dissection (figure).
Figure. Magnetic resonance T2 axial image of right internal carotid artery dissection. Image shows presence of mural hematoma (hyperintense signal) at the base of the cranium in the region of the inferior jugular foramen.
Discussion. Spontaneous extracranial ICA dissections may include cranial nerve deficits as part of the clinical presentation, and cranial nerves II to XII are all susceptible to injury.1 The mechanism of nerve damage varies depending on the vascular supply to that nerve and the anatomic proximity of that nerve to the ICA. Angiographic studies and clinical correlates have shown that cranial nerves III, IV, V1, VI and, occasionally, II derive vascular supply from the inferolateral trunk of the intracavernous …
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