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We describe the case of a 57-year-old woman who developed severe left-sided neck pain followed by difficulty chewing, oropharyngeal dysphagia, and dysarthria. Clinically, she developed an isolated left-sided deviation of the tongue with protrusion; an isolated cisternal hypoglossal nerve palsy. A magnetic resonance angiogram imaging study revealed a left V4 cisternal vertebral artery dissection with normal diffusion-weighted imaging of the lower medulla. We outline the anatomy, histology, and pathophysiology of ischemic injury of nerve trunks and briefly review the recent trials of vertebral and carotid artery dissections.

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Isolated Palsy of the Cisternal Segment of the Hypoglossal Nerve Due to Arterial Dissection of the V4 Segment of the Vertebral Artery: A Case Report With a Side Note on Nerve Trunk Ischemia