Villaret's syndrome caused by internal carotid artery dissection

Abstract

We report a patient with Villaret's syndrome (left hypoglossopharyngeal nerve, vagus nerve, accessory nerve, and hypoglossal nerve palsies and left Horner's sign) caused by internal carotid artery dissection. He had neck pain on the left side, Horner's sign on the left side and paralysis of the left hypoglossopharyngeal nerve, vagus nerve, accessory nerve, and hypoglossal nerve. Brain MRI revealed no signal from the left internal carotid artery and no brain infarction, although a tumor-like lesion was observed in the left internal carotid artery. Subsequent MRI studies revealed intramural hematoma in the left internal carotid artery, and on the basis of this finding, he was diagnosed with internal carotid artery dissection. He received anticoagulant and antiplatelet therapy. His symptoms improved gradually. The symptoms of internal carotid artery dissection are neck pain, Horner's sign, brain infarction, and lower cranial nerve palsy. A characteristic feature in this case was that brain infarction was not observed. Only 3 similar cases have been reported in the past In all these cases, the patients had a good clinical course and showed complete recovery from the symptoms. Compared with western countries, in Japan, carotid artery dissection is rare. Carotid artery dissection should be considered as a differential diagnosis of lower cranial nerve palsy.

A case of bilateral internal carotid artery dissection in young adult with cranial nerve IX and X palsies

“…The pathogenesis of the cranial nerve IX-XII palsies is due to the nerve compression by dilated ICA within the same carotid sheath, or due to nerve necrosis by ascending pharyngeal artery stenosis feeding these cranial nerves from ICA. 2 In the present case, dilatation of left ICA was evident in MRA (Fig. 1e) which could compress the left cranial nerve IX and X.…”

“…Almost half of ICA dissection presents cervical pain and headache, and 6.2–9.0% of the patients presented cranial nerve palsy common in XII and V and rarely in IX, III, X, and XI. The pathogenesis of the cranial nerve IX–XII palsies is due to the nerve compression by dilated ICA within the same carotid sheath, or due to nerve necrosis by ascending pharyngeal artery stenosis feeding these cranial nerves from ICA . In the present case, dilatation of left ICA was evident in MRA (Fig.…”

A rare presentation of spontaneous internal carotid artery dissection with Horner's syndrome, VIIth, Xth and XIIth nerve palsies

“…Two of these syndromes, Villaret's and Collet Sicard, have been previously reported in the literature as a consequence of sICAD [ 3 , 4 ]. Tapia's syndrome, first described by a Spanish Otolaryngologist Antonio Garcia Tapia in 1904, has been variously interpreted by different authors and there is little agreement currently on the symptoms included in this syndrome.…”

Successfully Treated with Endovascular Therapy against Lower Cranial Nerve Paresis Caused by Spontaneous Dissection of the Cervical Internal Carotid Artery: A Case Report

“…There were 29 patients with idiopathic dissection of the cervical internal carotid artery and inferior cranial neuropathy, as presented in Table 1. [5][6][7][8][9][10][11][12][13][14] The proportion of males was high (86%, n = 25). The mean age was 46.6 years (28-63 years).…”