Spontaneous Internal Carotid Dissection Presenting With Pulsatile Tinnitus and Hearing Loss

Internal carotid artery (ICA) dissection often presents with headache and neck pain, along with symptoms related to the anterior circulation if stroke occurs. Less commonly, it may cause Horner's syndrome and involvement of the lower cranial nerves (IX, X, XI, and XII). However, it is rare for ICA dissection to present with pulsatile tinnitus and hearing loss, which is typically linked to vertebral artery dissection. We report a rare case of a man in his 50s who initially presented to the Otolaryngology Department with a brief episode of high-pitched pulsatile tinnitus and hearing loss, preceded by left-sided headache, ptosis, dysarthria, and dysphagia. Neurological examination revealed facial numbness in the trigeminal nerve territory, mild left facial weakness, and left sensorineural hearing impairment. Magnetic resonance angiography (MRA) confirmed a left ICA dissection without evidence of vertebral artery involvement. He was managed conservatively with dual antiplatelet therapy and scheduled for follow-up computed tomography (CT) angiography. To the best of our knowledge, this is the first case report highlighting the simultaneous involvement of cranial nerves V, VII, VIII, IX, and X, along with Horner's syndrome, due to ICA dissection.