• F A Bravo-Rodríguez, F Delgado-Acosta, A Cano-Sánchez, M J Ramos-Gómez, J J Ochoa-Sepúlveda, and J M Vida-López.
• Servicio de Radiodiagnóstico, Hospital Universitario Reina Sofía, Córdoba, España.
• Rev Neurol. 2002 Apr 16; 34 (8): 754-7.

IntroductionDissection of the internal carotid artery (DIC) is a known cause of cerebral infarct, especially in young patients. The classical clinical syndrome consists of unilateral pain of the head or neck, homolateral oculo-sympathetic paresis and ischaemic symptoms of the cerebral hemisphere involved. Presentation as paralysis of cranial nerves is rare and occurs in less than 12% of cases. The neurological involvement seems to be due to compression caused by the increased diameter of the artery involved.Case ReportsTwo patients are reported with paralysis of the lower cranial nerves secondary to DIC. In the first case there was paralysis of the left cranial nerves IX, X, and XII which was diagnosed on angiography using computerized tomography with spiral acquisition. The second patient had clinical involvement of cranial nerves IX, X, XI and XII and magnetic resonance angiography showed the dissection. Both cases were confirmed after digital subtraction angiography.ConclusionDiagnosis of DIC requires a high level of suspicion in cases with atypical onset. The use of new techniques of non invasive imaging diagnosis such as computerized tomography and magnetic resonance angiography permit effective diagnosis of this disorder.

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