Thorotrast, a contrast medium containing radioactive thorium, was in use in the period 1930 to 1945. It is retained in the body after use, with harmful effects, including the induction of malignancies. Accidental, extravasal injection during carotid angiography results in cervical granulomas with progressive, local damage. A case is reported in which lesions of the vagus, glossopharyngeal, hypoglossal and facial nerves have developed over a 40-year period after carotid angiography. A limited removal of the injected Thorotrast was carried out and, in the postoperative period, rupture of the arterial wall necessitated ligation of the common carotid artery. No additional complications arose from this. The therapeutic implications are discussed