open access

Vol 52, No 2 (2018)
Case reports
Submitted: 2017-07-29
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Hypoglossal nerve palsy in the course of dissection of the internal carotid arteries – Case reports

Magdalena Torbus-Paluszczak, Sebastian Mucha, Maciej Wawrzyńczyk, Krystyna Pierzchała, Wojciech Bartman, Monika Adamczyk-Sowa
DOI: 10.1016/j.pjnns.2017.08.012
·
Neurol Neurochir Pol 2018;52(2):267-273.

open access

Vol 52, No 2 (2018)
Case reports
Submitted: 2017-07-29

Abstract

Internal carotid artery dissection (ICAD) has become an increasingly recognized cause of cerebrovascular accidents in young and middle-aged patients. We report 2 cases of hypoglossal nerve palsy in the course of dissection of the internal carotid arteries. The first patient was admitted to the Department of Neurology due to swallowing difficulty, speech articulation disorders and numbness of the right half of the tongue for 4 weeks. Extracranial vessel ultrasound (US) and transcranial colour Doppler (TCD) visualized thrombus causing occlusion of the right internal carotid artery (RICA). Angio-CT revealed a compression on right XII nerve and a dissection of the RICA. The second patient was referred to the Department of Neurology due to articulation disorders and swallowing difficulties. On admission, neurological examination revealed tongue deviation towards the right side with evidence of atrophy of the right half of the tongue, deviation of the uvula to the right side, absence of palatal and pharyngeal reflexes, rhinolalia and dysphagia. Vessel imaging was taken using angio-MR showing mural thrombus of the RICA.

Conclusion

The diagnosis of spontaneous non-traumatic dissection of the carotid arteries is a major challenge for clinicians. ICAD must be considered for young and middle-aged patients when severe headache is preceded by the co-existence of focal neurological symptoms. The probability of ICAD increases in the presence of predisposing diseases. The final diagnosis is based on imaging studies: color duplex ultrasound, CT angiography or MR angiography.

Abstract

Internal carotid artery dissection (ICAD) has become an increasingly recognized cause of cerebrovascular accidents in young and middle-aged patients. We report 2 cases of hypoglossal nerve palsy in the course of dissection of the internal carotid arteries. The first patient was admitted to the Department of Neurology due to swallowing difficulty, speech articulation disorders and numbness of the right half of the tongue for 4 weeks. Extracranial vessel ultrasound (US) and transcranial colour Doppler (TCD) visualized thrombus causing occlusion of the right internal carotid artery (RICA). Angio-CT revealed a compression on right XII nerve and a dissection of the RICA. The second patient was referred to the Department of Neurology due to articulation disorders and swallowing difficulties. On admission, neurological examination revealed tongue deviation towards the right side with evidence of atrophy of the right half of the tongue, deviation of the uvula to the right side, absence of palatal and pharyngeal reflexes, rhinolalia and dysphagia. Vessel imaging was taken using angio-MR showing mural thrombus of the RICA.

Conclusion

The diagnosis of spontaneous non-traumatic dissection of the carotid arteries is a major challenge for clinicians. ICAD must be considered for young and middle-aged patients when severe headache is preceded by the co-existence of focal neurological symptoms. The probability of ICAD increases in the presence of predisposing diseases. The final diagnosis is based on imaging studies: color duplex ultrasound, CT angiography or MR angiography.

Get Citation

Keywords

Internal carotid artery dissection, Hypoglossal nerve palsy

About this article
Title

Hypoglossal nerve palsy in the course of dissection of the internal carotid arteries – Case reports

Journal

Neurologia i Neurochirurgia Polska

Issue

Vol 52, No 2 (2018)

Pages

267-273

DOI

10.1016/j.pjnns.2017.08.012

Bibliographic record

Neurol Neurochir Pol 2018;52(2):267-273.

Keywords

Internal carotid artery dissection
Hypoglossal nerve palsy

Authors

Magdalena Torbus-Paluszczak
Sebastian Mucha
Maciej Wawrzyńczyk
Krystyna Pierzchała
Wojciech Bartman
Monika Adamczyk-Sowa

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