Isolated vagal nerve palsy associated with a dissection of the extracranial internal carotid artery

A 40-year-old man had paralysis of the right vocal cord. Imaging showed a dissection of the extracranial internal carotid artery, and physical examination disclosed paresis of the right side of the soft palate, To our knowledge, this is only the second report of carotid dissection presenting as an isolated vagal neuropathy, Most often, multiple lower cranial nerves are involved. The CT, MR imaging, and MR angiographic findings are presented and the topic is reviewed.