title: Vocal cord paralysis secondary to spontaneous internal carotid dissection: case report and systematic review of the literature.
abstract: OBJECTIVE
  To present a rare case of unilateral vocal cord paralysis (VCP) secondary to spontaneous internal carotid artery dissection and to perform a literature review.
  
  
  METHODS
  A 35-year-old male presented to the emergency department with acute onset hoarseness and dysphagia. History, physical exam and laryngoscopy revealed left sided VCP without obvious cause. Magnetic Resonance Imaging (MRI) demonstrated a left internal carotid artery dissection of unknown etiology. Neurovascular surgery was consulted and treatment with aspirin was initiated. The dysphagia and hoarseness resolved in 12 weeks with long-term neurosurgery follow-up as the management plan.
  
  
  METHODS
  Systematic literature review was conducted by 3 independent reviewers. Since 1988 only 9 cases of VCP due to internal carotid artery dissection have been reported. These were reviewed for: demographics, diagnostic method, treatment and vocal cord function.
  
  
  RESULTS
  7 patients had unilateral while 2 had bilateral VCP. MRI was used for diagnosis in 7 cases and 5 cases utilized a type of angiography. All received antithrombotic treatment with 5 out of the 9 patients experiencing vocal cord recovery in an average of 7.2 weeks.
  
  
  CONCLUSIONS
  MRI is crucial in the work-up of idiopathic VCP. If an ipsilateral internal carotid artery dissection is found, antithrombotic treatment is initiated with an expectation that vocal cord mobility is likely to return.
authors.affiliation: Division of Otolaryngology-Head and Neck Surgery, University of Alberta, Edmonton, AB, Canada. r_see_00@yahoo.ca.
authors.forename: T T Jean
authors.initials: TT
authors.lastname: Nguyen
authors.forename: Han
authors.initials: H
authors.lastname: Zhang
authors.forename: Peter T
authors.initials: PT
authors.lastname: Dziegielewski
authors.forename: Robert
authors.initials: R
authors.lastname: Seemann
mesh_terms: D000328:Adult; D001241:Aspirin / Q000627:therapeutic use; D020215:Carotid Artery, Internal, Dissection / Q000150:complications* / Q000175:diagnosis; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D014826:Vocal Cord Paralysis / Q000175:diagnosis / Q000209:etiology*
chemical_list: D005343:Fibrinolytic Agents; D001241:Aspirin