Guy N, Deffond D, Gabrillargues J, Carriere N, Dordain G, Clavelou P
Fédération de Neurologie, CHU de Clermont Ferrand, France.
Can J Neurol Sci. 2001 Aug;28(3):265-9. doi: 10.1017/s031716710000144x.
Typical presentation of spontaneous internal carotid artery (ICA) dissection is an ipsilateral pain in neck and face with Horner's syndrome and contralateral deficits. Although rare, lower cranial nerve palsy have been reported in association with an ipsilateral spontaneous ICA dissection.
We report three new cases of ICA dissection with lower cranial nerve palsies.
The first symtom to appear was headache in all three patients. Examination disclosed a Horner's syndrome in two cases (1 and 2), an isolated XIIth nerve palsy in two patients (case 1 and 3) and IX, X, and XIIth nerve palsies (case 2) revealing an ipsilateral carotid dissection, confirmed by MRI and angiography. In all cases, prognosis was good after a few weeks.
These cases, analysed with those in the literature, led us to discuss two possible mechanisms: direct compression of cranial nerves by a subadventitial haematoma in the parapharyngeal space or ischemic palsy by compression of the ascending pharyngeal artery.
自发性颈内动脉（ICA）夹层的典型表现是颈部和面部同侧疼痛伴霍纳综合征及对侧神经功能缺损。虽然罕见，但已有同侧自发性ICA夹层伴下颅神经麻痹的报道。
我们报告3例新发的伴下颅神经麻痹的ICA夹层病例。
所有3例患者出现的首个症状均为头痛。检查发现2例（病例1和2）有霍纳综合征，2例患者（病例1和3）有孤立的舌下神经麻痹，1例患者（病例2）有舌咽、迷走和舌下神经麻痹，提示同侧颈动脉夹层，经MRI和血管造影证实。所有病例数周后预后良好。
将这些病例与文献中的病例进行分析后，我们探讨了两种可能的机制：咽旁间隙中外膜下血肿对颅神经的直接压迫，或咽升动脉受压导致的缺血性麻痹。
