Traumatic dissection of the internal maxillary artery associated with isolated glossopharyngeal nerve palsy: case report.
OBJECTIVE
Spontaneous or traumatic dissection of the internal carotid artery with resultant lower cranial nerve palsies is well documented. However, dissection of the external carotid artery with lower cranial palsies has not been reported previously.


METHODS
A 42-year-old man experienced an epidural hematoma as the result of a fall and underwent a craniotomy and hematoma removal. Subsequently, he developed dysgeusia and difficulty in swallowing. Brain magnetic resonance imaging showed a dilated linear structure, with isosignal intensity on T1-weighted images and hyperintense signal intensity on T2-weighted images. Strong enhancement was seen on postcontrast T1-weighted images, indicating a dissected internal maxillary artery. This was confirmed on selective angiography of the left common carotid artery.


METHODS
Guglielmi detachable coils were introduced into the false lumen of the dissected artery. Subsequently, 0.5 ml of glue mixed with Lipiodol (Lafayette Pharmacal, Lafayette, IN) was packed into the remnant of the false lumen. Repeat angiograms demonstrated complete occlusion of the dissected vessel. The patient's postoperative course was uneventful, and the neurological deficits gradually improved.


CONCLUSIONS
We describe the first reported case of internal maxillary artery dissection and pseudoaneurysm presenting with isolated glossopharyngeal nerve palsy. The association between cranial nerve palsy and dissection of the external carotid artery branch may be the result of a compressive mechanism, as suggested by its anatomic relationships, the characteristics of the dissection, and the good prognosis. Endovascular embolization of the external carotid artery dissection and pseudoaneurysm is suggested as an effective therapeutic method for improving or alleviating neurological deficits produced by mass effect.
Ahn
Jung Yong
JY
Department of Neurosurgery, Pundang CHA Hospital, Pochon CHA Medical University, Sungnam, South Korea.
Chung
Young Sun
YS
Chung
Sang Sup
SS
Yoon
Pyeong Ho
PH
D000058:Accidental Falls; D000328:Adult; D000784:Aortic Dissection / Q000150:complications* / Q000175:diagnosis* / Q000209:etiology / Q000601:surgery; D015901:Angiography, Digital Subtraction; D001921:Brain / Q000473:pathology; D003680:Deglutition Disorders / Q000209:etiology; D003937:Diagnosis, Differential; D004408:Dysgeusia / Q000209:etiology; D020435:Glossopharyngeal Nerve Diseases / Q000150:complications*; D006407:Hematoma, Epidural, Cranial / Q000209:etiology / Q000601:surgery; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008438:Maxillary Artery; D010243:Paralysis / Q000150:complications*