Epistaxis complicating a severe craniofacial injury is not unusual, but in most cases bleeding is easily controlled by nasal packs. On the other hand, epistaxis as a major manifestation of traumatic aneurysm of the internal carotid artery is reported to be rare. When this occurs, however, prognosis is grave and the treatment creates a perplexing nenrosurgical problem.In the case of penetrating injury involving the head and face, the correct diagnosis of the source of bleeding is usually made. When the epistaxis occurs weeks after the closed head injury, however, its direct relation to the previous injury is often not so apparent and easily escapes the attention of both patient and physician. In fact, causal relationship between preceding trauma and present epistaxis is only occasionally identified when the patient is first seen with an epistaxis from a traumatic aneurysm of the internal carotid artery.We have treated four consecutive cases of traumatic aneurysm of the internal carotid artery. Two of them came under our care in a one month period. From this experience, we are inclined to believe that traumatic aneurysm of the internal carotid artery is less rare than previous reports would indicate. It is this belief that prompted the present article.In all four cases the aneurysm was verified either by carotid angiography or at autopsy, or both. In three of them, severe recurrent epistaxis was observed. In the remaining one, delayed epistaxis was absent but this ease is of particular interest as the aneurysm was associated with a homolateral carotieocavernous fistula and both of them were followed up by means of repeat angiographic studies over several months. Report of CasesCase I: Tra]]ic accident. Epidural haematoma evacuated. Severe ~'ecurrent epistaxis. Exsanguination. Autopsy. G. M., a 19-year-old man, was involved in a traffic accident. A depressed fracture in the left frontal region, linear fractures in the right frontal and Act~ Neurochirurgica, Vol. XVII, Fast. 3 II

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