1. A 63 year old man with headaches
Teaching NeuroImages
Neurology
Resident and Fellow Section
© 2013 American Academy of Neurology

2. Presentation 6 week history headache, hoarseness and dysphagia.
left-sided Horner’s syndrome
wasting of the left sternocleidomastoid muscle.
tongue deviated to the left on protrusion
Okpala et al.
© 2013 American Academy of Neurology

3. Imaging Okpala et al. Fig. 1 Fig. 2 A A B B C
Figure 1: Cranial nerve palsies in Villaret’s syndrome
Figure 1A: Left Horner’s sign
Figure 1B: Wasting of the left sternocleidomastoid muscle
Figure 1C: Deviation of the tongue to the left
Figure 2: Radiological evaluation of carotid artery dissection
Figure 2A: Axial T2 weighted MRI shows normal flow void in the right internal carotid artery (thin arrow). The flow void of the left ICA (thick arrow) is narrowed by the medially positioned intramural haematoma which is of mixed signal intensity (arrowhead).
Figure 2B: CT angiography shows a pseudoaneurysm of the left internal carotid artery (thin arrow) proximal to an area of luminal stenosis (arrowhead) C
Okpala et al.
© 2013 American Academy of Neurology

4. “Internal carotid artery dissection presenting as Villaret’s Syndrome”
IX,X, XI and XII cranial nerve palsies together with Horner’s sign.
pathology is in the retroparotid space, as this is the only area where the lower four cranial nerves and sympathetic fibres to the eye lie in close proximity.
References
(1) Villaret M. Le syndrome nerveux de l'espace rétro-parotidien postérieur. Rev Neurol 1916;29:
(2) Collet FJ. Sur un nouveau syndrome paralytique pharyngo-larynge par blessure de guerre (hemiplegie glosso-laryngo-scapulo-pharyngee). Lyon Medical 1915;124:121–9.
Okpala et al.
© 2013 American Academy of Neurology