The patient has a small pupil and mild ptosis on the left, as well as weakness of the tongue muscles on the left side. The combination of Horner’s syndrome and ipsilateral hypoglossal palsy is typically caused by carotid dissection in the neck:the outward bulge of the artery caused by subadventitial dissection can lead to dysfunction of the surrounding sympathetic plexus as well as of the hypoglossal nerve, which runs across the carotid artery. Cranial nerves IX to XI may also be affected. In this patient the abnormalities spontaneously cleared within a few weeks.
Sturzenegger M, Huber P (1993) Cranial nerve palsies in spontaneous carotid artery dissection. Journal of Neurology, Neurosurgery and Psychiatry, 56, 1191–9.
MRI showed moderate to severe asymmetric frontoparietotemporal atrophy, greater on the left than on the right. This image is characteristic of corticobasal degeneration.
Corticobasal degeneration is a progressive neurodegenerative disease and
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