Spontaneous parapharyngeal haematoma caused by a leaking vertebral artery pseudoaneurysm

We describe an unusual case of spontaneous parapharyngeal haematoma, in a patient with haemophilia. The cause was a leaking extracranial vertebral artery pseudoaneurysm eroding through the atlas at the level of the skull base. The leaking pseudoaneurysm was successfully controlled with embolisation of the vertebral artery. The haematoma caused a cerebral infarct and vocal cord paralysis, requiring external drainage and tracheostomy. This is the first reported case of a parapharyngeal haematoma originating from a vertebral artery pseudoaneurysm where imaging demonstrated a causal link.