Vocal cord palsy resulting from spontaneous carotid dissection.
OBJECTIVE
Vocal cord palsy has a variety of causes, such as malignant tumors of the thyroid, lung, or upper mediastinum, aortic aneurysm, surgery of the thyroid, and infectious diseases.


METHODS
Case report.


METHODS
A 43-year-old biologist had a holocephalic headache and right-sided neck pain for 1 day. Five days later, he developed paralysis of the right-side vocal cord. In addition, an angiotensin converting enzyme (ACE) inhibitor was administered because the patient had high systolic and diastolic blood pressures, which were formerly not known to the patient. Five days after admission, a temporary sensorimotor hemiparesis occurred.


RESULTS
Neurological examination revealed, in addition to the known paralysis of the right-side vocal cord, right-side palatoplegia, right-side hypoglossal nerve palsy, and mild dysphagia. Duplex sonography showed evidence of lumen narrowing of the right-side internal carotid artery caused by an hypoechogenic mural hematoma. Magnetic resonance imaging (0.5 T, Philips Gyroscan) revealed a circumscribed dissection of the right-side internal carotid artery from the carotid bifurcation to the petrosal segment. The diffusion-weighted magnetic resonance imaging scan of the brain also demonstrated multiple embolic ischemic lesions in the right hemisphere.


CONCLUSIONS
Internal carotid artery dissection must be included in the differential diagnosis of lower cranial nerve palsy and should be assessed by duplex ultrasonography and magnetic resonance imaging.
Wessels
Tiemo
T
Department of Neurology, Aachen University Medical School, Pauwelsstrasse 30, 52057 Aachen, Germany. tiemo.wessels@gmx.net
Sparing
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R
Neuschaefer-Rube
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Klötzsch
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D000328:Adult; D020215:Carotid Artery, Internal, Dissection / Q000150:complications* / Q000473:pathology / Q000601:surgery; D006801:Humans; D007002:Hypoglossal Nerve / Q000503:physiopathology; D008279:Magnetic Resonance Imaging; D008297:Male; D014826:Vocal Cord Paralysis / Q000209:etiology* / Q000503:physiopathology / Q000601:surgery