Peripheral Facial Nerve Palsy due to Spontaneous Internal Carotid Artery Dissection

TL;DR

A rare case of facial nerve palsy was linked to a spontaneous carotid artery dissection, highlighting the need for vascular imaging in such cases.

Contribution

This case report identifies hypoperfusion as a novel cause of facial nerve palsy in spontaneous carotid artery dissection.

Findings

Facial nerve palsy can result from hypoperfusion of the vasa nervorum in sCeAD.

Lower cranial nerve palsies are typically caused by mass effect from mural hematomas in sCeAD.

Vascular imaging is crucial for identifying sCeAD in patients with peripheral facial nerve palsy.

Abstract

A man in his 50s experienced novel, continuous, and progressive headache and neck pain prior to the onset of left‐sided peripheral facial nerve palsy. Sequential palsies of left lower Cranial Nerves IX and XII followed. Imaging showed spontaneous cervical artery dissection (sCeAD) of the ipsilateral internal carotid artery. Lower cranial nerve palsies in sCeAD are a frequent result of a local mass effect exerted by the formation of a mural hematoma. The only close topographical relationship between the facial nerve and the internal carotid artery is within the petrous part of the temporal bone but still separated in two different bony canals (facial canal and carotid canal). Thus, a mural hematoma of an internal carotid artery dissection could not cause compression of the facial nerve. In the rare case of facial nerve palsy due to sCeAD, hypoperfusion of the vasa nervorum is the most likely cause. As sCeAD is one of the main reasons for stroke in the youth, it is critical to know and identify potential red flags in patients with peripheral facial nerve palsy, which should lead to additional vascular imaging.

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