Joshi Binisha, Bolaji Paul, Chun Yae, Ubur Ahmet, Prasad Lakshminarayana Hoskere Krishna
Internal Medicine, Stroke Medicine, Dorset County Hospital, Dorchester, GBR.
Neurology, Stroke Medicine, Dorset County Hospital, Dorchester, GBR.
Cureus. 2025 Jul 30;17(7):e89099. doi: 10.7759/cureus.89099. eCollection 2025 Jul.
Internal carotid artery (ICA) dissection often presents with headache and neck pain, along with symptoms related to the anterior circulation if stroke occurs. Less commonly, it may cause Horner's syndrome and involvement of the lower cranial nerves (IX, X, XI, and XII). However, it is rare for ICA dissection to present with pulsatile tinnitus and hearing loss, which is typically linked to vertebral artery dissection. We report a rare case of a man in his 50s who initially presented to the Otolaryngology Department with a brief episode of high-pitched pulsatile tinnitus and hearing loss, preceded by left-sided headache, ptosis, dysarthria, and dysphagia. Neurological examination revealed facial numbness in the trigeminal nerve territory, mild left facial weakness, and left sensorineural hearing impairment. Magnetic resonance angiography (MRA) confirmed a left ICA dissection without evidence of vertebral artery involvement. He was managed conservatively with dual antiplatelet therapy and scheduled for follow-up computed tomography (CT) angiography. To the best of our knowledge, this is the first case report highlighting the simultaneous involvement of cranial nerves V, VII, VIII, IX, and X, along with Horner's syndrome, due to ICA dissection.
颈内动脉（ICA）夹层通常表现为头痛和颈部疼痛，若发生卒中则伴有与前循环相关的症状。较少见的情况下，它可能导致霍纳综合征以及较低颅神经（IX、X、XI和XII）受累。然而，ICA夹层以搏动性耳鸣和听力损失为表现较为罕见，后者通常与椎动脉夹层有关。我们报告一例罕见病例，一名50多岁男性最初因短暂的高音调搏动性耳鸣和听力损失就诊于耳鼻喉科，之前有左侧头痛、上睑下垂、构音障碍和吞咽困难。神经系统检查发现三叉神经区域面部麻木、左侧轻度面瘫以及左侧感音神经性听力障碍。磁共振血管造影（MRA）证实为左侧ICA夹层，无椎动脉受累证据。他接受了双联抗血小板治疗的保守治疗，并安排了后续的计算机断层扫描（CT）血管造影检查。据我们所知，这是首例强调由于ICA夹层导致颅神经V、VII、VIII、IX和X同时受累以及霍纳综合征的病例报告。
