Corazza Elisa, Lorenzut Simone, Valente Mariarosaria, Gigli Gian Luigi, Merlino Giovanni
Neurology Clinic, Udine University Hospital, Udine, Italy.
Stroke Unit, Udine University Hospital, Udine, Italy.
Case Rep Neurol. 2019 Apr 23;11(1):137-141. doi: 10.1159/000499449. eCollection 2019 Jan-Apr.
Internal carotid artery dissection is a frequent cause of stroke in young people. The artery dissection and the formation of an intramural hematoma could also cause mass effect on surrounding structures, causing disorders such as cranial nerve palsies (about 12% of the cases), including XII cranial nerve. In the setting of an ischemic stroke, lower cranial nerve palsy could also be due to infratentorial ischemic lesions; however, there have been also rare reports of lower cranial nerve palsy due to supratentorial cerebral ischemic lesions. We describe a case of a 55-year-old man who presented with right internal carotid artery dissection and deviation to the left of the protruded tongue. The direction of the deviation of the protruded tongue was unexpected in this patient, because if the XII nerve palsy was due to mass effect related to the intramural hematoma of the dissected artery, a deviation to the right should have happened. Anyway, a subsequent magnetic resonance revealed also an acute ischemic lesion in the right tongue area in the primary motor cortex of the patient, providing a rare, but a fitting neuroanatomical explanation of the deviation and also providing clinical evidence of functional dominance of the crossed projections of the cortico-lingual tracts.
颈内动脉夹层是年轻人中风的常见原因。动脉夹层和壁内血肿的形成也可能对周围结构产生占位效应，导致诸如颅神经麻痹（约占病例的12%）等病症，包括第十二对颅神经。在缺血性中风的情况下，低位颅神经麻痹也可能是由于幕下缺血性病变引起的；然而，也有罕见的报道称幕上脑缺血性病变可导致低位颅神经麻痹。我们描述了一例55岁男性患者，其表现为右颈内动脉夹层且伸舌偏向左侧。该患者伸舌偏斜的方向出乎意料，因为如果第十二对颅神经麻痹是由于与夹层动脉壁内血肿相关的占位效应所致，那么应该出现向右偏斜。无论如何，随后的磁共振成像显示该患者初级运动皮层的右侧舌区也存在急性缺血性病变，这为这种偏斜提供了一种罕见但恰当的神经解剖学解释，也为皮质 - 舌束交叉投射的功能优势提供了临床证据。
