Pseudoaneurysm of the Internal Carotid Artery: A Warning of a Septic Erosion

Abstract

Swelling of the upper part of the neck and parotid region combined with swelling of the lateral wall of the pharynx after a pharyngeal infection (pharyngitis or tonsillitis) indicates a parapharyngeal abscess. This abscess may be complicated by involvement of the nerves and vessels passing this region. Thus in our cases neurological symptoms from n. glossopharyngeus, n. vagus, n. accessorius and n. hypoglossus and the cervical sympathetic nerves were seen as well as erosion of the internal carotid artery. On erosion of an artery either the vessel wall is perforated directly or generally a pseudoaneurysm may form before the rupture of the vessel. Therefore early diagnosis of a pseudoaneurysm of the internal carotid artery is very important so that ligation can be done before the often fatal rupture. It is demonstrated that repeated minor haemorrhages from the nose and throat and Horner's syndrome are typical symptoms of a pseudoaneurysm of the internal carotid artery. The reason why the sympathetic nerve is affected may be the close anatomical relationship between the internal carotid artery and the sympathetic plexus running along the artery upwards through the carotid canal. The importance of early diagnosis of the pseudoaneurysm and immediate ligation of the internal carotid artery is stressed. In order to avoid unnecessary ligation, an angiography should be performed to verify the diagnosis. The incidence of cerebral complications following ligation of the internal carotid artery is discussed.