Differential Diagnosis of an unilateral Odynophagia

Introduction A primary dissection of the extracranial brain-supplying vessels is caused by hemorrhage of the Vasa vasorum into Tunica media or in between Tunica media and Tunica adventitia. The incidence of spontaneous dissection, a dissection without an initiating event or following a minor trauma, is 2,5-3/1000.000 and leads to an Insult in 70 % if untreated.

Methods A 54-year-old female patient arrived as an emergency presentation at the hospital with the following symptoms: fatigue, odynophagia, tongue pain and otalgia. Stridor, dyspnoea, fever and dysphagia were denied.

Results The clinical examination, including ultrasound, couldn’t detect any pathologies. The patient only described a pain on palpation at the right side of her neck in regio II without clinical findings. The patient discharged herself without seeing an attending. 4 weeks later she turned herself in at the urgent care of the department of neurology, describing intermittent visual impairment. The clinical examination couldn’t detect any pathologies. The MRI Angio TOF revealed a complete blockage of the right ACI by a blood clot with suspicion of an acute microinfarct of the right corona radiata. After emergency hospitalization they started the oral anticoagulation treatment with Phenprocoumon.

Conclusion A spontaneous dissection of the ACI is a rear but severe differential diagnoses of an unilateral odynophagia without infect parameters and clinical findings. The interdisciplinary cooperation and possibility of performing an imaging should always be considered, by leaking clinical findings to specific symptoms, to prevent the best medical supply of each patient.

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Publication History

Article published online:
07 August 2020