Majeed Azer, Ribeiro Nuno Pedro Lobato, Ali Asem, Hijazi Mohsen, Farook Hina
Stroke Unit , Scunthorpe General Hospital , Scunthorpe , UK.
Stroke Unit , Diana Princess of Wales Hospital , Grimsby , UK.
Oxf Med Case Reports. 2016 Oct 1;2016(10):omw078. doi: 10.1093/omcr/omw078. eCollection 2016 Oct.
Spontaneous internal carotid artery dissection (sICAD) is an uncommon cause of isolated cranial nerve palsies. Commonly patients present with stroke, headache, facial pain and Horner's syndrome, with upto 16% having cranial nerve palsies. We present the case of a 55-year-old man who presented with hoarseness, dysphagia and tongue swelling, mimicking a tongue base tumor. He was found to have unilateral VIIth, Xth and XIIth nerve palsies with Horner's syndrome. Magnetic resonance imaging showed high signal changes and loss of signal void in right internal carotid artery, later confirmed by Angiography as a dissection with pseudo-aneurysm. He was started on anticoagulation and made a good recovery on discharge. This case presents a unique combination of cranial nerve palsies due to internal carotid artery dissection (ICAD) and to our knowledge is the first reported case in the literature. Early recognition and institution of appropriate therapy is critical to prevention of ischemic stroke.
自发性颈内动脉夹层（sICAD）是孤立性颅神经麻痹的一种罕见病因。患者通常表现为中风、头痛、面部疼痛和霍纳综合征，高达16%的患者伴有颅神经麻痹。我们报告一例55岁男性病例，其表现为声音嘶哑、吞咽困难和舌肿胀，类似舌根肿瘤。检查发现他有单侧第七、第十和第十二颅神经麻痹并伴有霍纳综合征。磁共振成像显示右侧颈内动脉有高信号改变和信号流空消失，血管造影后来证实为伴有假性动脉瘤的夹层。他开始接受抗凝治疗，出院时恢复良好。该病例呈现了因颈内动脉夹层（ICAD）导致的颅神经麻痹的独特组合，据我们所知，这是文献中首次报道的病例。早期识别并采取适当治疗对于预防缺血性中风至关重要。
