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Abstract Details

Duplicate Cervical Internal Carotid Artery with Dissecting Pseudoaneurysm presenting with Ipsilateral Bell’s Palsy
Cerebrovascular Disease and Interventional Neurology
Cerebrovascular Disease and Interventional Neurology Posters (7:00 AM-5:00 PM)
235
Description of a rare duplicate cervical internal carotid artery (ICA) with dissecting pseudoaneurysm presenting with ipsilateral peripheral facial palsy in two patients.
Peripheral facial nerve palsy (FNP) is an unusual symptom of ipsilateral cervical ICA dissecting pseudoaneurysm. Duplication of cervical ICA is even a rare congenital anomaly. We here first reported two duplicate cervical ICA with dissection presenting with ipsilateral facial nerve palsy.

Case Series. First patient was a 53-year-old Caucasian female with history of hypertension, and polysubstance abuse (Methamphetamine and Marijuana) presented with acute onset of left FNP. Physical examination showed left whole face weakness with loss of taste. Brain MRI showed no acute ischemic stroke, while neck angiography (CTA) reported an cervical dissecting pseudoaneurysm. Cerebral digital subtractive angiography (DSA) revealed the mid cervical ICA had duplication and there was a  pseudoaneurysm (6.5 X 13 mm) at one of the duplicate segment of cervical ICA. 

Second case is a 44-year-old Caucasian female with history of migraine, hyperlipidemia and hypertension who presented with new onset of left FNP. Examination only revealed a left full face weakness without loss of taste. Neck CTA showed a large pseudoaneurysm in the cervical left ICA. DSA showed an 18 x 5 mm dissection aneurysm on one of the duplicate cervical ICA segment. 
Both patient had complete resolution of FNP in a few days. The pseudoaneurysms were treated conservatively with patients were treated with Aspirin 325mg with planned follow-up image studies. 
Peripheral FNP from cervical ICA dissection is unusual. It was thought due to disruption of the arterial supply to the nerve, or the mass effect on the genicular ganglion from pseudoaneurysm. Therefore, a complete evaluation of FNP may include the evaluation of cervical artery, especially among those with neck injury.  . This is the first time report of peripheral FNP from duplicate cervical carotid dissection. 
Authors/Disclosures
Naga Krishnakanth Madireddy, MD (Baptist Health Louisville)
PRESENTER 		Dr. Madireddy has nothing to disclose.
Shivani Naik, MD (Cedar Sinai Medical Center) Dr. Naik has nothing to disclose.
Kerri S. Remmel, MD, PhD (Regional Brain Institute) Dr. Remmel has nothing to disclose.
Wei Liu, MD Dr. Liu has nothing to disclose.