Villaret's Syndrome Secondary to Internal Carotid Artery Dissection: A Case Report

Villaret's syndrome is a rare neurological condition characterized by ipsilateral palsies of the cranial nerves (CNs) IX, X, XI, and XII in association with Horner's syndrome. We report a 52-year-old man presenting with headache, hoarseness of voice, and dysphagia following strenuous exercise. Physical examination revealed left-sided lower CN palsies and partial Horner's syndrome, implying pathology in the retroparotid space, the only anatomical site where these nerves are colocated. Initial stroke computed tomography head and angiogram were reported as unremarkable, but a subsequent magnetic resonance imaging (MRI) of the head and neck demonstrated an expansile cervical internal carotid artery dissection (ICAD) as the underlying cause. The patient was managed with dual antiplatelet therapy and achieved full symptomatic resolution within six weeks. This case underscores that ICAD can present as Villaret's syndrome without cerebral ischemia. It also highlights that a "normal" computed tomography angiography does not exclude dissection; targeted MRI is more sensitive for detecting intramural pathology in suspected lower CN syndromes.