Spontaneous internal carotid artery dissection with lower cranial nerve palsy.
BACKGROUND
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.


METHODS
We report three new cases of ICA dissection with lower cranial nerve palsies.


RESULTS
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.


CONCLUSIONS
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.
Guy
N
N
Fédération de Neurologie, CHU de Clermont Ferrand, France.
Deffond
D
D
Gabrillargues
J
J
Carriere
N
N
Dordain
G
G
Clavelou
P
P
D000925:Anticoagulants / Q000627:therapeutic use; D002340:Carotid Artery Diseases / Q000150:complications*; D002533:Cerebral Angiography; D002547:Cerebral Palsy / Q000150:complications; D003389:Cranial Nerve Diseases / Q000150:complications*; D006261:Headache / Q000209:etiology; D006732:Horner Syndrome / Q000473:pathology; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged
D000925:Anticoagulants