Tongue necrosis as an unusual presentation of carotid artery stenosis

Abstract

A 57-year-old man with premature coronary artery disease presented to the emergency department with left facial pain, numbness, and tongue swelling. The patient was found to have significant tongue necrosis, and subsequent arteriography demonstrated carotid bifurcation stenosis with embolization to the left lingual artery. The patient was successfully treated with debridement of his tongue and left carotid endarterectomy.

Acute hemifacial ischemia as a late complication of carotid stenting

“… 1 , 3 Cold-triggered neck pain, facial pain, and cyanosis and necrosis of ear, preauricular region, and tongue have also been described. 13 , 14 , 15 …”

Ischaemic necrosis of the tongue

“…Case reports also exist of other causes of lingual necrosis including vasopressor use, radiotherapy, antiphospholipid syndrome, disseminated intravascular coagulation, fungal infection and secondary to carotid artery stenosis 2–4 6 9 10. A case series has also been published recently documenting lingual necrosis secondary to severe hypotension in cardiogenic shock.…”

OUP accepted manuscript

“…Tongue necrosis has most frequently been associated with giant cell arthritis [1–5], as seen in temporal arthritis, often diagnosed by a high erythrocyte sedimentation rate [1, 2, 6, 7]. It may also occur with cardiogenic shock [1], leading to end-organ hypoperfusion.…”

“…Tongue necrosis has also been associated with vascular diseases such as, Kawasaki disease [7, 8], Wegener granulomatosis [1, 3, 6], hypercoagulable condition such as disseminated intravascular coagulation and rheumatoid hyperviscosity syndrome [6].…”