Internal carotid artery dissection and pseudoaneurysm formation with resultant ipsilateral hypoglossal nerve palsy

Abstract

Craniocervical artery dissection is a potentially disabling condition caused by an intimal tear allowing blood to enter and dissect the media in the cranial direction which can occur spontaneously or as a result of trauma. When the dissection extends toward the adventitia, it can form a protrusion from the weakened vessel wall called a pseudoaneurysm, which may become a nidus for distal thromboembolism or cause mass effect on adjacent structures. Accurate and prompt diagnosis is critical as timely treatment can significantly reduce the risk of complications such as stroke. Here, we present a case of cervical ICA dissection and pseudoaneurysm formation causing mass effect with resultant compressive ipsilateral hypoglossal nerve palsy.

Isolated Unilateral Hypoglossal Nerve Palsy Caused by Internal Carotid Artery Loop

“…HN is immediately adjacent to the carotid artery in the carotid space. Because of the location of the ICA in the carotid space, vessel enlargement may lead to dysfunction of the lower cranial nerves [1,8]. While hypoglossal segment is relatively sheltered from major vessels, it might be affected by redundant vascular structures such as dural AV fistula, enlarged emissary vein, persistent hypoglossal artery, or by a loop as in our case.…”

False Aneurysms Complicating Internal Carotid Artery Dissection

“…10 Cranial nerve XII along with nerves IX, X, and XI are most commonly involved, but there were also cases with isolated palsy of hypoglossal nerve. 8 When the cavernous segment of ICA is affected, it can cause oculomotor nerve paresis and ophthalmoplegia. 11 Horner syndrome, presented in our third patient, is due to compression, stretching, or hypoperfusion of the sympathetic fibers within the carotid wall.…”

“…The most common symptoms in patients with carotid artery dissection are neck or head pain, Horner syndrome, and cerebral ischemia. 8,9 The ICA pseudoaneurysms can cause mass effect on adjacent structures, and consequences are dependent on the location involved. 10 Cranial nerve XII along with nerves IX, X, and XI are most commonly involved, but there were also cases with isolated palsy of hypoglossal nerve.…”

Early Detection of Superior Mesenteric Artery Dissection by Ultrasound

“…Dissection of an artery may result in thrombosed aneurysm, and the aneurysm is usually defined as more than 1.5 times of normal diameter. [7] The normal diameter of the SMA has been reported as 5.7–7.3 mm in ultrasound images. [8] Based on these diameters, we propose the diameter of a dissected SMA to range from 8.5 to 11 mm when SMA dissection is combined with aneurysm formation.…”