Hemiplegia as a Complication of Therapeutic Embolisation of the Internal Maxillary Artery

Abstract

SUMMARYA hemiplegia complicating a successfully treated angioma arising from the internal maxillary artery is described. The probable pathogenesis of the complication is discussed.A right common carotid arteriogram and a selective right external carotid arteriogram were carried out.The common carotid arteriogram showed that the intra‐cerebral arteries were normal. The external carotid arteriogram showed an enlarged main stem and a greatly enlarged internal maxillary artery (Figure 1). A rapid series of films in the antero‐posterior and lateral projections were taken and subtraction films prepared, to identify the feeding vessels to the arterio‐venous malformation and to exclude any connections between the external and internal carotid arterial systems.The internal maxillary artery and its branches were the only feeding vessels demonstrated as supplying a large arterio‐venous malformation situated in the pterygo‐palatine fossa (Figure 2).Because of the anatomical site of the angioma and its wide ramification, it was decided that the most suitable method of treatment would be embolisation of the main feeding arteries rather than an attempt at surgical removal.Following embolisation the patient developed a hemiplegia. A C.T. Scan confirmed the presence of an area of infarction in the right hemisphere of the brain. The hemiplegia slowly improved over a period of four months but left a residual partial paralysis of the left arm.The embolisation therapy was successful in abolishing the bruit and the vascular hum complained of by the patient.