Hypoglossal nerve palsy due to internal carotid artery dissection with pseudoaneurysm formation: An unusual presentation

Internal carotid artery (ICA) dissection is a dangerous condition that results from disruption of the intimal part of the wall of the internal carotid artery. It is a rare disease that may occur spontaneously or as a result of a trauma. Spontaneous dissections of the carotid artery are rare but important causes of ischemic stroke because they usually affect young and middle-aged patients. Up to date, only a few cases were described in the literature about ICA dissection causing isolated cranial nerve palsies, with the Hypoglossal nerve being the most affected. Here, we report a case of a 56-year-old man presenting with progressive dysarthria, dysphagia to liquid diet, and difficult mastication. He was diagnosed as a case of cervical internal carotid dissection with pseudoaneurysm formation causing mass effect resulting in a compressive ipsilateral Hypoglossal nerve palsy based on magnetic resonance imaging (MRI) findings. Angiography confirmed the presence of dissecting pseudoaneurysm which was eventually managed by stenting. This case was reported to highlight and emphasize the importance of radiology, whether diagnostic or interventional, in managing rare and challenging cases such as ICA dissection.