[Headache and hypoglossal nerve palsy].

Area of Science:

• Neurology
• Vascular Medicine
• Otolaryngology

Background:

• Cranial nerve palsies, particularly isolated hypoglossal nerve palsy, are uncommon presentations.
• Internal carotid artery dissection is a critical condition that can lead to stroke.
• Simultaneous occurrence of headaches and cranial nerve deficits warrants thorough investigation.

Observation:

• A 52-year-old male presented with sudden headaches, neck itching, oral paresthesia, chewing difficulties, and right-sided tongue deviation.
• The patient had a history of nicotine use.
• Magnetic Resonance Imaging (MRI) revealed an intraluminal increase in signal intensity within the right internal carotid artery.

Findings:

• The patient's symptoms were attributed to an intraluminal increase in signal intensity in the right internal carotid artery.
• This finding, in conjunction with the isolated hypoglossal nerve palsy and headache, strongly suggested internal carotid artery dissection.
• Nicotine use may be a contributing factor or risk factor.

Implications:

• This case underscores the necessity of considering internal carotid artery dissection in patients presenting with isolated cranial nerve palsies, especially when accompanied by headaches.
• Early diagnosis and management of internal carotid artery dissection are crucial to prevent ischemic stroke.
• The presentation emphasizes the importance of advanced imaging techniques like MRI in diagnosing vascular pathologies affecting cranial nerves.