A 35-year-old male was admitted to the Emergency Department because of major head trauma. Brain CT showed acute subdural hematoma and right temporal pole parenchymal hemorrhage. He was intubated for airway protection but was extubated successfully soon thereafter. After sedation withdrawal, the neurological examination showed a deficit of the 9th, 10th, 11th, and 12th cranial nerves as well as Horner’s sign, consistent with left Villaret syndrome. Cerebral magnetic resonance angiography displayed left extracranial internal carotid artery dissection along with a dissecting pseudoaneurysm (DP), causing compression of the lower 4 cranial nerves and sympathetic fibers and 80% lumen stenosis (Fig.
1a). Acetylsalicylic acid 100 mg daily was started after the resolution of the hemorrhagic lesions, 1 month after the acute event. At 3-month follow-up evaluation, we observed improvement of compressive signs, whereas neuroimaging indicated no further expansion of the vascular lesion...
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