Iris Publishers- Open access Journal of Otolaryngology and Rhinology | Internal Carotid Artery Dissection Causing Lower Cranial Neuropathies

Authored by Clare Perkins

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. As a recognised cause of acute stroke, particularly in younger patients, spontaneous carotid artery dissection is an important diagnosis to recognise. 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, clinical presentation can be varied, subtle and often challenging to make, with many different presentations described. The most commonly described symptom is pain in either the head, neck or face, and tends to be unilateral [3]. Partial Horner’s syndrome is also a common symptom [4], found in up to 50% of patients [3], as well as symptoms secondary to cerebral ischaemia. However, there are several less common symptoms associated with spontaneous carotid artery dissection which many different specialties should be able to recognise, including cranial nerve palsies. Unilateral cranial nerve palsies, particularly of the lower cranial nerves, are a recognised sign in up to 12% of cervical artery dissections.

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