Abstract :
[en] of the brain and supra-aortic arteries revealed a dissection of the left intrapetrous ICA. Brain MRI ruled out cerebral ischemia and confirmed acute left ICA dissection. Interestingly, none of these scans confirmed the clinical impression of increased volume of the left tongue. A volumetric study of the tongue was conducted on CT images: both hemi-tongue volumes were indeed comparable (28,64 and 28,82 cm³, for left and right hemi-tongues, respectively), establishing the absence of edema (Fig. 2). Antiplatelet therapy was initiated. Clinical evolution was favorable. The apparent enlargement disappeared, the tongue palsy evolved towards muscle atrophy, which eventually regressed completely. The dysphonia improved through speech therapy. Discussion Hypoglossal nerve paralysis manifested by an enlarged ipsilateral hemi-tongue has already been reported after ICA dissection [2, 3]. Patients typically present with dysarthria, dysphagia and tongue deviation, sometimes combined with other cranial nerve manifestations. The aneurysmal dilatation of the dissected ICA is suspected to compress the hypoglossal nerve or its vasa nervorum, resulting in a denervation that secondarily promotes a fluid shift to the lingual extracellular spaces [3]. However, this pathophysiological explanation does not account for the present imaging volumetric data, revealing a symmetric tongue, despite the clinical impression of swelling. The bulk of the tongue is made of the fan-shaped genioglossus muscle, which, when contracted, depresses and protrudes the tongue anteriorly, keeping the oropharyngeal airway open [4]. Due to the hydrostatic properties of the tongue, this compression leads to upward and forward movement of the upper part of the tongue [5]. By contrast,
