A carotid artery dissection presenting with dysphagia due to a dilation of upper oesophagus

Carotid and vertebral artery dissection is one of the major causes of ischemic stroke in young patients and diagnosing it remains a challenge for the clinician due to its variable clinical presentation. We report the case of a 57-years old man admitted to the emergency department complaining of dysphagia and a hoarse voice. Physical examination revealed a left deviation of his tong and some weakness of the left side of his soft palate. A gastroscopy and a cervical tomodensitometry revealed the presence of an important dilation of his upper oesophagus. A cerebral magnetic resonance was performed, showing en excentric high signal intensity on the left carotid artery, and the MR angiography confirmed the presence of an acute dissection on the left internal carotid artery. Our patient suffered of a left carotid artery dissection presenting with ipsilateral Xth and XIIth nerve palsies. His main symptom was a dysphagia due to a dilation of his upper oesophagus; the pneumogastric nerve being responsible for the parasympathic innervation of the upper muscles of the oesophagus.