Cervical Internal Carotid Artery Aneurysm: Spontaneous Dissection of the Cervical Internal Carotid Artery Resulting in Elongation and Pseudoaneurysm Formation Causing Hypoglossal Nerve Palsy; Endovascular Vessel Reconstruction with Stenting, Followed by Telescoping Flow Diversion, Achieving Straightening of the Artery, Aneurysm Occlusion, Hypoglossal Nerve Recovery, and Normalization of the Tongue

  • Hosni Abu Elhasan
  • Pablo Albiña Palmarola
  • Marta Aguilar Pérez
  • Birgit Herting
  • Hansjörg Bäzner
  • Hans HenkesEmail author
Living reference work entry


A 48-year-old male patient, with a history of intermittent atrial fibrillation, endogenous depression, and Meulengracht syndrome, presented 2 days after the acute onset of a paralysis of the right-hand side of his tongue, causing dysarthria and difficulty swallowing. When he stuck out his tongue, it deviated to the right. Otherwise, his neurological condition was within normal limits, and the diagnosis of an acute hypoglossal nerve palsy was made. Magnetic resonance imaging and angiography (MRI, MRA), followed by diagnostic digital subtraction angiography (DSA), showed a 360° loop and a dissecting aneurysm in his right cervical internal carotid artery (ICA) just proximal to the petrous segment. The maximum neck and fundus diameters were 6 mm and 11 mm, respectively. Endovascular treatment was carried out, starting with balloon straightening of the ICA followed by deploying a self-expanding Carotid Wallstent (Boston Scientific) into the affected ICA segment. Follow-up examinations after 2 months showed a straightened ICA with persistent perfusion of the false ICA lumen and the dissecting aneurysm. A p64 flow diverter (phenox) was implanted inside the Carotid Wallstent. DSA 3 months later confirmed the occlusion of the pseudoaneurysm and the false lumen. The hypoglossal nerve palsy disappeared within 2 months after the first treatment in which the ICA had been straightened. Hypoglossal nerve palsy due to ICA dissection with pseudoaneurysm formation, including management of this condition, is the main topic of this chapter.


Cervical internal carotid artery Hypoglossal nerve palsy Dissecting pseudoaneurysm Carotid Wallstent Flow diversion p64 


  1. Anson J, Crowell RM. Cervicocranial arterial dissection. Neurosurgery. 1991;29(1):89–96. Scholar
  2. Baumgartner RW, Arnold M, Baumgartner I, Mosso M, Gönner F, Studer A, Schroth G, Schuknecht B, Sturzenegger M. Carotid dissection with and without ischemic events: local symptoms and cerebral artery findings. Neurology. 2001;57(5):827–32. Scholar
  3. Biggs KL, Chiou AC, Hagino RT, Klucznik RP. Endovascular repair of a spontaneous carotid artery dissection with carotid stent and coils. J Vasc Surg. 2004;40(1):170–3. Scholar
  4. Bogousslavsky J, Pierre P. Ischemic stroke in patients under age 45. Neurol Clin. 1992;10(1):113–24.CrossRefGoogle Scholar
  5. CADISS trial investigators, Markus HS, Hayter E, Levi C, Feldman A, Venables G, Norris J. Antiplatelet treatment compared with anticoagulation treatment for cervical artery dissection (CADISS): a randomised trial. Lancet Neurol. 2015;14(4):361–7. Scholar
  6. Campos-Herrera CR, Scaff M, Yamamoto FI, Conforto AB. Spontaneous cervical artery dissection: an update on clinical and diagnostic aspects. Arq Neuropsiquiatr. 2008;66(4):922–7. Scholar
  7. Chen PR, Edwards NJ, Sanzgiri A, Day AL. Efficacy of a self-expandable porous stent as the sole curative treatment for extracranial carotid pseudoaneurysms. World Neurosurg. 2016;88:333–41. Scholar
  8. Cohen JE, Leker RR, Gotkine M, Gomori M, Ben-Hur T. Emergent stenting to treat patients with carotid artery dissection: clinically and radiologically directed therapeutic decision making. Stroke. 2003;34(12):e254–7. Scholar
  9. Desfontaines P, Despland PA. Dissection of the internal carotid artery: aetiology, symptomatology, clinical and neurosonological follow-up, and treatment in 60 consecutive cases. Acta Neurol Belg. 1995;95(4):226–34.PubMedGoogle Scholar
  10. Freilinger T, Heuck A, Strupp M, Jund R. Images in vascular medicine: hypoglossal nerve palsy due to internal carotid artery dissection. Vasc Med. 2010;15(5):435–6. Scholar
  11. Fusco MR, Harrigan MR. Cerebrovascular dissections – a review part I: spontaneous dissections. Neurosurgery. 2011;68(1):242–57.; discussion 257. Scholar
  12. Gobert M, Mounier-Vehier F, Lucas C, Leclerc X, Leys D. Cranial nerve palsies due to internal carotid artery dissection: seven cases. Acta Neurol Belg. 1996;96(1):55–61.PubMedGoogle Scholar
  13. Gonzales-Portillo F, Bruno A, Biller J. Outcome of extracranial cervicocephalic arterial dissections: a follow-up study. Neurol Res. 2002;24(4):395–8. Scholar
  14. Houser OW, Mokri B, Sundt TM Jr, Baker HL Jr, Reese DF. Spontaneous cervical cephalic arterial dissection and its residuum: angiographic spectrum. AJNR Am J Neuroradiol. 1984;5(1):27–34.PubMedGoogle Scholar
  15. Keane JR. Twelfth-nerve palsy. Analysis of 100 cases. Arch Neurol. 1996;53(6):561–6. Scholar
  16. Kurre W, Bansemir K, Aguilar Pérez M, Martinez Moreno R, Schmid E, Bäzner H, Henkes H. Endovascular treatment of acute internal carotid artery dissections: technical considerations, clinical and angiographic outcome. Neuroradiology. 2016;58(12):1167–79. Scholar
  17. Leblanc A. Anatomy and imaging of the cranial nerves. Berlin/Heidelberg/New York: Springer-Verlag; 1992.CrossRefGoogle Scholar
  18. Lyrer P, Engelter S. Antithrombotic drugs for carotid artery dissection. Stroke. 2004;35(2):613–4. Scholar
  19. Lyrer P, Engelter S. Antithrombotic drugs for carotid artery dissection. Cochrane Database Syst Rev. 2010;10:CD000255. Scholar
  20. Matsuura JH, Rosenthal D, Jerius H, Clark MD, Owens DS. Traumatic carotid artery dissection and pseudoaneurysm treated with endovascular coils and stent. Endovasc Surg. 1997;4(4):339–43.<0339:TCADAP>2.0.CO;2.CrossRefGoogle Scholar
  21. Mokri B, Silbert PL, Schievink WI, Piepgras DG. Cranial nerve palsy in spontaneous dissection of the extracranial internal carotid artery. Neurology. 1996;46(2):356–9. Scholar
  22. Moon K, Albuquerque FC, Cole T, Gross BA, McDougall CG. Stroke prevention by endovascular treatment of carotid and vertebral artery dissections. J Neurointerv Surg. 2017;9(10):952–7. Scholar
  23. National Collaborating Centre for Chronic Conditions (UK). Stroke: national clinical guideline for diagnosis and initial management of acute stroke and transient ischaemic attack (TIA). London: Royal College of Physicians (UK); 2008.Google Scholar
  24. Olzowy B, Lorenzl S, Guerkov R. Bilateral and unilateral internal carotid artery dissection causing isolated hypoglossal nerve palsy: a case report and review of the literature. Eur Arch Otorhinolaryngol. 2006;263(4):390–3. Scholar
  25. Schievink WI. The treatment of spontaneous carotid and vertebral artery dissections. Curr Opin Cardiol. 2000;15(5):316–21. Scholar
  26. Schievink WI. Spontaneous dissection of the carotid and vertebral arteries. N Engl J Med. 2001;344(12):898–906. Scholar
  27. Schievink WI, Mokri B, Whisnant JP. Internal carotid artery dissection in a community. Rochester, Minnesota, 1987–1992. Stroke. 1993;24(11):1678–80. Scholar
  28. Stino AM, Smith BE, Temkit M, Reddy SN. Hypoglossal nerve palsy: 245 cases. Muscle Nerve. 2016;54(6):1050–4. Scholar
  29. Woll MM, Goff JM Jr, Gillespie DL, Minken SL. Bilateral spontaneous dissection of the internal carotid arteries--a case report. Vasc Surg. 2001;35(3):221–4. Scholar

Copyright information

© Springer Nature Switzerland AG 2020

Authors and Affiliations

  • Hosni Abu Elhasan
    • 1
  • Pablo Albiña Palmarola
    • 2
  • Marta Aguilar Pérez
    • 3
  • Birgit Herting
    • 4
  • Hansjörg Bäzner
    • 5
  • Hans Henkes
    • 3
    Email author
  1. 1.Department of NeurosurgeryHadassah Medical CenterJerusalemIsrael
  2. 2.Clínica BicentenarioHospital Barros Luco TrudeauSantiagoChile
  3. 3.Neuroradiologische KlinikKlinikum StuttgartStuttgartGermany
  4. 4.Klinik für Neurologie und GerontoneurologieDiakonie-Klinikum Schwäbisch HallSchwäbisch HallGermany
  5. 5.Neurologische KlinikKlinikum StuttgartStuttgartGermany

Personalised recommendations