The Internal Carotid is much more tortuous in its course and supplies the anterior parts of the brain, eye and its appendages, forehead and the nose. It may have either one or two flexures near the base of the skull and its course follows a distinctive S shape along the Sphenoid bone of the skull. The Internal Carotid has been provided different names depending upon its course and regional relations. The different regions have been named the cervical, petrous, cavernous and the cerebral regions of the Internal Carotid Artery. It is positioned more towards the middle line of the neck. The cervical portion does not give off any branches but the rest three do. The petrous region gives off Caroticotympanic, Artery of the Pterygoid canal, Cavernous, Hypophyseal and the semilunar branches; the cavernous region gives off the Anterior Meningeal, Ophthalmic Anterior Cerebral and Middle Cerebral branches and the cerebral region of the Internal Carotid gives off Posterior Communicating and Choroidal branches. The wall of the large arteries such as carotid artery consists of three layers – intima, the innermost layer lined by endothelial cells on the luminal side and internal elastic lamina on the outside, the middle layer containing smooth muscle cells and the outer adventitia made up of connective tissue, fibroblasts and smooth muscle cells (Abayomi. 2004). The patient was a 59-year-old white male with a history of hypertension, diabetes and CABG in 1994 (Goldman. 2004). He was an ex-smoker and a pacemaker was implanted in 1997 as he was suffering from bradycardia. In 1999, he developed hoarseness of voice and was diagnosed as positive for laryngeal squamous cell carcinoma. After 2 months of radiation therapy, there was an improvement in his condition and he did not experience any deterioration until 2003. However, subsequently, he complained of dysphonia, diplopia and dizziness. Further tests revealed hypothyroidism and he was accordingly treated with levothyroxine. However, his condition did not improve and he complained of visual disturbance as well as continued hoarse voice.
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