Middle cerebral artery infarction following common carotid compression due to a multiloculated parapharyngeal abscess

Abstract

Deep neck space infections (DNSIs) include retropharyngeal and parapharyngeal abscesses. We report a rare complication of left-sided middle cerebral artery infarction precipitated by left common carotid artery compression secondary to a multiloculated parapharyngeal abscess. A 59-year-old woman with poorly controlled diabetes was admitted following a loss of consciousness. Examination demonstrated unilateral right-sided hemiparesis and computed tomography (CT) of the brain revealed an acute left-sided frontoparietal infarct. The patient had been complaining of a fever, left-sided ear redness and pain six days prior. Unfortunately, despite antibiotics in the community, her ear pain worsened to involve her left jaw. Closer examination revealed a swelling in her left submandibular region and a CT of her neck was performed, revealing a multiloculated left parapharyngeal abscess with evidence of left common carotid compression. A naso-pharyngo-laryngoscopy (NPLS) was performed to confirm the presence of an abscess. Owing to the size and complex location of the abscess, management via a prolonged antibiotic treatment was opted for over surgical intervention. After completion there was improvement in medical state and resolution on repeat NPLS. Vascular-related complications are rare following DNSI. Carotid artery compression has been reported, although current literature suggests it to be a benign phenomenon. Our case is the first reported instance of a parapharyngeal abscess with severe neurological complications, reminding physicians that such complications following a DNSI remain possible. Although rare, in the event of a cerebrovascular accident and sepsis, DNSI remains a possible cause to be considered.