Internal carotid artery dissection presenting with glossopharyngeal nerve dysfunction: A case report

Area of Science:

• Neurology
• Vascular Surgery
• Radiology

Background:

• Internal carotid artery dissection (ICAD) is a rare cause of ischemic stroke, particularly in young adults.
• ICAD commonly presents with headache, neck pain, or stroke symptoms.
• However, ICAD can also manifest as isolated cranial nerve palsies, complicating diagnosis.

Observation:

• A 45-year-old woman presented with isolated glossopharyngeal nerve symptoms (ageusia, pharyngeal discomfort) and mild neck pain.
• Initial otolaryngology evaluation did not reveal the cause.
• Imaging confirmed spontaneous dissection of the right internal carotid artery.

Findings:

• The internal carotid artery dissection (ICAD) extended from the cervical spine to the petrous segment.
• Diagnosis was confirmed via magnetic resonance angiography and digital subtraction angiography.
• Conservative management with aspirin resulted in symptom improvement and near-complete dissection resolution at 180 days.

Implications:

• This case demonstrates ICAD presenting without cerebral ischemic findings, with isolated glossopharyngeal nerve involvement.
• The glossopharyngeal nerve symptoms were likely due to localized compression from the dissection.
• This case underscores the need to consider ICAD in the differential diagnosis of lower cranial nerve palsies, even without typical stroke symptoms.