Spontaneous dissection of the carotid artery presenting with lower cranial nerve palsies

Spontaneous dissections of the internal carotid arteries are uncommon. Rarely, these dissections may present with cranial nerve palsies causing dysphonia, dysarthria, dysphasia, and oropharyngeal hypesthesia. Affected patients may initially be referred to the otolaryngologist. A recent review of spontaneous dissection of the internal carotid artery producing cranial nerve palsies at our institution identified nine patients. Headache, oculo-sym-palhelic palsy, and cerebral ischemia were not universally present in this group of patients. The diagnosis may be difficult to obtain, and in one case, was made only at surgical exploration. A detailed discussion of the outcome of these patients, as well as a review of 47 case reports from the literature, will be presented. We found that conservative management will result in a satisfactory outcome in most of these patients. Theories as to the pathophysiology of this rare condition will be reviewed.