title: Vocal Cord Paralysis as the First Sign of Spontaneous Carotid Dissection in a Patient With Extracranial Internal Carotid Artery Aneurysm.
abstract: BACKGROUND
  Spontaneous dissection of supra-aortic arteries is an exceptionally rare cause of vocal cord dysfunction. We are reporting a case of spontaneous carotid dissection and internal carotid artery aneurysm presenting as vocal cord paralysis.
  
  
  METHODS
  A 44-year-old female was admitted with hoarseness and swallowing disorders. Diagnostic imaging revealed dissection and obliteration of the right internal carotid artery (ICA) 23 mm from the carotid bifurcation. Electromyography revealed unilateral paralysis/paresis of the right vocal cord. Genetic analyses for thrombophilia, methylenetetrahydrofolate reductase, and plasminogen activator inhibitor 1 were found to be at high risk. The patient was discharged after 5 days without any neurological findings, and control angiography revealed complete restitution of the flow in the right ICA one month later. However, a fusiform aneurysm of the distal part of the extracranial right ICA was detected and excluded with endovascular procedure.
  
  
  CONCLUSIONS
  Connective tissue systemic disorders and even mild trauma could initiate the dissection process of neck arteries. Precise diagnosis might be difficult even for an experienced neurologist, however, the final outcome is favorable.
authors.affiliation: Vascular Surgery Clinic, "Dedinje" Cardiovascular Institute, Belgrade, Serbia School of Medicine, Belgrade University, Belgrade, Serbia.
authors.forename: Petar
authors.initials: P
authors.lastname: Popov
authors.affiliation: Klinik für Radiologie und Neuroradiologie, Alfried Crupp Krankenhouse Rüttenschield, Essen, Deutchland.
authors.forename: Rene
authors.initials: R
authors.lastname: Chapot
authors.affiliation: Vascular Surgery Clinic, "Dedinje" Cardiovascular Institute, Belgrade, Serbia drslobex@yahoo.com.
authors.forename: Slobodan
authors.initials: S
authors.lastname: Tanasković
authors.affiliation: Surgery Department, DrDragiša Mišović, University Medical Center, Baddour Parkway, LB, USA.
authors.forename: Berislav
authors.initials: B
authors.lastname: Vekić
authors.affiliation: Vascular Surgery Clinic, "Dedinje" Cardiovascular Institute, Belgrade, Serbia.
authors.forename: Vuk
authors.initials: V
authors.lastname: Sotirovic
authors.affiliation: Vascular Surgery Clinic, "Dedinje" Cardiovascular Institute, Belgrade, Serbia.
authors.forename: Nenad
authors.initials: N
authors.lastname: Ilijevski
authors.affiliation: Vascular Surgery Clinic, "Dedinje" Cardiovascular Institute, Belgrade, Serbia Surgery Department, DrDragiša Mišović, University Medical Center, Baddour Parkway, LB, USA.
authors.forename: Djordje
authors.initials: D
authors.lastname: Radak
mesh_terms: D000328:Adult; D000784:Aortic Dissection / Q000150:complications* / Q000000981:diagnostic imaging / Q000628:therapy; D025861:Blood Coagulation Disorders, Inherited / Q000150:complications / Q000175:diagnosis / Q000235:genetics; D002340:Carotid Artery Diseases / Q000150:complications* / Q000000981:diagnostic imaging / Q000628:therapy; D002343:Carotid Artery, Internal / Q000000981:diagnostic imaging; D000072226:Computed Tomography Angiography; D004576:Electromyography; D057510:Endovascular Procedures; D005260:Female; D006801:Humans; D061330:Multidetector Computed Tomography; D011237:Predictive Value of Tests; D012307:Risk Factors; D016896:Treatment Outcome; D014826:Vocal Cord Paralysis / Q000175:diagnosis / Q000209:etiology*
keywords: carotid artery; dissection; paralysis; vocal cord