| 英文摘要 |
Dissection of the internal carotid artery (ICA) can cause paralysis of lower cranial nerves. This study presents a rare case of vagus nerve palsy, secondary to spontaneous dissection of extracranial ICA. A 55-year-old healthy man suffered hoarseness for 5 days. Paralysis of left vocal cord was identified via a laryngoscope examination. Phonation evaluation showed moderate to severe dysphonia. Computed tomography (CT) of the head and neck region identified medial displacement of the left vocal cord and intramural hematoma in the left cervical ICA at the level of the skull base. The results of a blood chemistry study and extensive immune evaluation were within normal ranges.
Antithrombotic therapy, Clopidogrel 75 mg QD, was applied under the impression of vagal nerve paralysis, secondary to spontaneous ICA dissection. The patient recovered and phonation was almost normal about 3 months after medical treatment. Restoration of the left vocal cord to a normal position and resolution of an intramural hematoma was confirmed by magnetic resonance imaging (MRI) after 3 months.
Pain in the head or neck, partial Horner’s syndrome and symptoms related to cerebral ischemia are most frequent presentations of spontaneous ICA dissection. Multiple lower cranial neuropathies involving cranial nerves IX, X, XI and XII have also been reported but isolated paralysis of vagal nerve secondary to spontaneous ICA dissection is extremely rare.
There are only 10 cases (F/M = 5/5, age = 29–63 y/o) in literature. Recovery after antithrombotic therapy requires 1–3 months for most of the reported cases. MRI is the imaging modality of choice for evaluating the evolution of an intramural hematoma in a dissected ICA. Stenting and coiling are reserved for patients with rapid symptom progression, despite medical treatment. In conclusion, spontaneous ICA dissection is a useful differential diagnosis for vocal cord palsy, especially for young adults with acute onset of hoarseness. |
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