Kidoguchi Takeshi, Fukui Issei, Abe Hiroyuki, Mori Kentaro, Tamase Akira, Yamashita Ryotaro, Takeda Mutsuki, Nakano Tatsu, Nomura Motohiro
Department of Neurosurgery, Yokohama Sakae Kyosai Hospital, Yokohama, Kanagawa, Japan.
Department of Neurology, Yokohama Sakae Kyosai Hospital, Yokohama, Kanagawa, Japan.
Surg Neurol Int. 2022 May 27;13:225. doi: 10.25259/SNI_184_2022. eCollection 2022.
Some studies reported cases of internal carotid artery (ICA) dissection (ICAD) that was treated by carotid artery stenting (CAS). Symptoms of ICAD resulting from the lower cranial nerve palsy are rare and the treatment strategy is not clearly defined. We report a patient with ICAD showing hypoglossal nerve palsy alone that was treated by CAS.
A 47-year-old man presented with headache, dysphagia, dysarthria, and tongue deviation to the left. He had no history of trauma nor any other significant medical history. Axial T2-CUBE MRI and MRA showed dissection of the left ICA accompanied with a false lumen. These findings indicated that direct compression by the false lumen was the cause of hypoglossal nerve palsy. Although medical treatment was continued, symptoms were not improved. Therefore, CAS was performed to thrombose the false lumen and decompress the hypoglossal nerve. His symptoms gradually improved after CAS and angiography performed at month 6 showed well-dilated ICA and disappearance of false lumen.
CAS may be an effective treatment for the lower cranial nerve palsy caused by compression by a false lumen of ICAD.
一些研究报道了经颈动脉支架置入术（CAS）治疗的颈内动脉（ICA）夹层（ICAD）病例。由低位颅神经麻痹导致的ICAD症状罕见，且治疗策略尚不明确。我们报告1例仅表现为舌下神经麻痹的ICAD患者，该患者接受了CAS治疗。
一名47岁男性，出现头痛、吞咽困难、构音障碍和舌头向左偏斜。他没有外伤史，也没有其他重大病史。轴向T2-CUBE MRI和MRA显示左ICA夹层伴假腔形成。这些发现表明假腔的直接压迫是舌下神经麻痹的原因。尽管继续进行药物治疗，但症状并未改善。因此，实施CAS以栓塞假腔并解除舌下神经压迫。CAS术后其症状逐渐改善，6个月时进行的血管造影显示ICA充分扩张，假腔消失。
CAS可能是治疗由ICAD假腔压迫导致的低位颅神经麻痹的有效方法。
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