Hypoglossal carotid entrapment syndrome

Inflammation of the upper respiratory tract if frequently contiguous with the ICA and the HN in the neck. If severe, the inflammation of itself may occlude or directly extent into the ICA wall. The resulting scar produces a fixed relationship between artery and nerve that is vulnerable to lymph node enlargement, by head position, or blood pressure elevation. Trauma in the absence of scar may result in intimal injury of the ICA. Hypoglossal carotid entrapment may give rise to arterial stricture or diaphragm formation, microembolism, dissecting aneurysm, and arterial occlusion. Hypoglossal palsy with hemiatrophy of the tongue, unilateral headache, facial pain, or sympathetic disturbance of the upper face are less common than carotid or vertebral basilar symptoms. The diagnosis of HCE depends on understanding the pathological anatomy, hemodynamics, and mechanics of its production and aggravation. Patient history is important and close attention should be given to a history of tonsillitis, abscesses of the neck, unilateral headache, facial or orbital pain, and symptoms related to activity or elevation of blood pressure. The judicious use of noninvasive hemodynamic evaluation, EEG, neurotologic studies, CT scan, and CT dynamic scanning has been of value in diagnosis before surgery and in the documentation of hemodynamic benefit after surgery. Surgical reconstruction has been successful in the relief of ICA obstruction due to HCE and of associated symptoms and disability.