A 41-year-old man presented with complaints of a left sided headache and difficulty manipulating food in his mouth. Examination revealed signs of lower motor neuron palsies of ix, x, xi, and xii nerves. A CT angiogram showed a left sided ICA dissection and a subsequent MRI head with gadolinium contrast showed dissection with the subsequent hematoma causing compression of the cranial nerves that explained his symptoms and signs.