Internal carotid artery dissection presenting as hypoglossal nerve palsy

Background: Carotid artery dissection is thought to be a consequence of a tear in the tunica intima, resulting in an intramural hematoma and creation of a false lumen. In such cases, thrombus formation and distal embolization may lead to ischemic stroke. Alternatively, the dissection plane separates the tunica media from the tunica adventitia, resulting in aneurysmal dilatation. This may result in compression of neighbouring structures. The clinical spectrum is diverse making the diagnosis illusive. Yet, carotid dissection is a main cause for strokes in young population, hence the importance of a timely diagnosis in order to minimize complications.