gms | German Medical Science

Patients with lower cranial nerve paralysis will be usually consulted by an otolaryngologist to rule out a skull base or parapharyngeal space tumour. However in rare instances a vascular etiology is possible that might be evident and readily recognizable or subtle and easily overlooked.

Methods: We present a case of a 73 y.o. female that presented with dysphonia, aspiration, velopharyngeal insufficiency, drooping and pain of the right shoulder. Paralysis of the right vocal cord, soft palate and right accessory nerve was evident.

Results: Native CT scan revealed asymmetry of the parapharyngeal space and contrast enhanced CT revealed coiling of the right internal carotid artery, tortuosity of the left. No stenosis of the lumen of the carotid was found. Ophtalmologic and neurologic consultations were unremarkable. The etiology of the paralysis was attributed to the mass effect of the carotid coil. The patient was put on antiagrigant and neurotropic therapy. Surgical repair of the carotid was regarded as risky. Two months later there was complete regression of symptoms. Currently 16 months after presentation the patient is without complaints.

Conclusion: This case contributes to the number of caudal cranial nerve palsies caused by carotid pathologies. While the hypoglossal nerve is most commonly involved it was not the case in this patient. MRI was not done and intramural subadventitial haematoma cannot be ruled out. However, the regression of symptoms supports such an etiology.

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