Acute onset of massive epistaxis due to post-traumatic cavernous internal carotid artery pseudoaneurysm

Abstract

Rationale: Cavernous internal carotid artery (ICA) pseudoaneurysm caused by non-penetrating head trauma is a rare cause of massive epistaxis. The sudden onset of epistaxis due to such a fatal aneurysm protruding into the sphenoid sinus is extremely rare in clinical practice. The management is often challenging because of anatomical inaccessibility of the bleeding point. Patient's concern: A 42-year-old man with a history of head trauma showing an ICA aneurysm eroding the sphenoid sinus followed by massive epistaxis. Diagnosis: A computerized tomography (CT) scan showed a fracture in the sphenoid sinus. CT angiogram revealed cavernous ICA pseudoaneurysm. Interventions: Endovascular coil embolization. Outcomes: The patient recovered well and was discharged without any neurological deficits Lessons: Cavernous ICA pseudoaneurysm may lead to a life-threatening situation. If a patient has a history of head trauma, post-traumatic cavernous ICA pseudoaneurysm should be considered a differential diagnosis of massive epistaxis.

Massive recurrent epistaxis in traumatic pseudoaneurysm of sphenopalatine artery: Report of 2 cases

“…Epistaxis, a flow of blood from the nasal fossae, is a common manifestation after a head injury. In most cases, it is benign and occurs because of a laceration of the nasal mucosa or tear of the anterior ethmoid or sphenopalatine artery after the head injury [1 , 11 , 12] . A facial fracture that contributes to trauma of the sphenopalatine artery may also lead to the formation of a pseudoaneurysm.…”

“…However, pseudoaneurysm formation from the sphenopalatine artery is extremely rare because its small caliber and deep location in the mid-face have proven to be protective from blunt and superficial penetrating injuries. The rarity of sphenopalatine artery pseudoaneurysm is due to the small size of the branches of the external carotid artery, which makes a complete cut more likely than a partial laceration [11 , 13] .…”

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