Fatal Subarachnoid Hemorrhage from an Inflammatory Cavernous Carotid Artery Aneurysm: Failure of Conservative Treatment After Early Diagnosis —Case Report—

Abstract

Inflammatory carotid artery aneurysm is a rare complication of acute paranasal sinusitis. A 50-year-old female presented with a ruptured giant carotid artery aneurysm secondary to infection of the sphenoid sinus and cavernous sinus. She had been healthy until 5 days before admission, when she developed orbital phlegmon and meningitis. She received antibiotic therapy for 10 days. Computed tomography (CT) of the brain 2 days after admission showed no abnormality. However, repeat CT on day 6 showed a round isodense mass in the suprasellar cistern suggesting a cerebral aneurysm. Twelve days after admission, she suffered a fatal subarachnoid hemorrhage. Cerebral angiography revealed a giant left cavernous carotid artery aneurysm with a very irregular shape. Autopsy found sphenoid sinusitis and osteomyelitis extending into the cavernous sinuses. Diagnosis of bacterial inflammatory aneurysms before rupture is very important. Appropriate surgical intervention should be considered if there is enlargement of the original aneurysm or appearance of a new aneurysm indicating a potentially dangerous situation.

Infectious aneurysm of the intracavernous carotid artery occurring concomitantly with sphenoid sinusitis; an autopsy case report

“…The first case of a bacterial or infectious aneurysm following sphenoid sinusitis was reported in 1992 by Hurst [8], and a total of 11 similar cases [2,3,5,[8][9][10][11][12][13][14] have been reported so far. Four of the 11 patients were immunocompromised; 2 had diabetes mellitus [11,14], 1 had an alcohol abuse problem [11], and 1 had undergone immunosuppressive therapy [9].…”

“…Although one of these patients died of the aneurismal rupture [11], the conditions of the other 7 patients improved [5,[8][9][10][11]13,14]. Other 3 cases treated only with antibiotics had a fatal outcome [2,3] or severe neurological sequelae [12].…”

“…Complications of sphenoid sinusitis, such as meningitis and cavernous sinus thrombosis, occur frequently because the sphenoid sinus is located adjacent to the cavernous sinus [1]. Only a few cases of intracavernous carotid infectious aneurysms following sphenoiditis, including autopsy cases, have been reported [2,3], and a detailed clinicopathological examination is exceedingly rare.…”

Intracavernous carotid artery aneurysms

“…SAH in series of ICCAAns varies from 0% to 40% (9% in combined series). 7,22,25,27,30 In our patients, there was only one SAH (16.6%).…”

Basilar Artery Vasculitis Secondary to Sphenoid Sinusitis. Case Report.

“…2,7,8,12,16,17) Most of the reported cases of vasculitis secondary to sphenoid sinusitis were associated with cavernous carotid artery aneurysms. 2,12,16,17) Cerebral ischemic complications of sphenoid sinusitis have occurred in only a few cases. 7,8) Furthermore, angiographic changes in the cerebral arteries causing ischemia have never been detected.…”