Hypoglossal nerve palsy after extensive vomiting

Dissection of the internal carotid artery (ICAD; Fig. 1) is not only widely accepted as an important component of stroke aetiology, it is also well recognised as a focal cause of lower cranial nerve palsy. In the present patient, a duplex ultrasound revealed a left, submandibular ICAD originating 3 cm distal to the ICA bifurcation. In parallel, a high-grade, long-distance stenosis was confirmed by a time-of-flight magnetic resonance angiogram. Axial T2-weighted MRI showed a crescent-like, hyperintense signal corresponding to an intramural haematoma. In addition, an asymptomatic dissecting vertebral artery (VA) aneurysm on the right V2-segment was