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Isolated hypoglossal nerve palsy due to internal carotid artery dissection
  1. Purwa Joshi1,
  2. David Bourke2
  1. 1 Clinical Measurement Unit, Department of Neurology, Wellington Hospital, Wellington, New Zealand
  2. 2 Department of Neurology, Capital and Coast District Health Board, Wellington, New Zealand
  1. Correspondence to Dr Purwa Joshi, Department of Neurology, Wellington Hospital, Riddiford Street, Newtown, Wellington 6021, New Zealand; purwa.joshi{at}ccdhb.org.nz

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Case

A normally healthy 52-year-old man developed a sudden-onset, left-sided frontal headache with intermittent sharp pain radiating to the left temple. A milder dull headache persisted for the next 2 weeks, when he suddenly developed slurred speech and difficulty chewing food in the left side of his mouth, leading him to present to the emergency department.

There was no history of head or neck trauma. He was a non-smoker with no known cardiovascular risk factors or other significant medical history. On examination, he had mild hypertension (148/94 mm Hg), mild lingual dysarthria and deviation of the tongue to the left, consistent with a left …

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