Acute onset of massive epistaxis due to post-traumatic cavernous internal carotid artery pseudoaneurysm: A case report (original) (raw)
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Epistaxis is commonly encountered by clinicians in emergency department. However, severe and recurrent epistaxis is very uncommon especially that arise from the cavernous internal carotid artery (ICA) pseudoaneurysm. Traumatic cavernous internal carotid pseudoaneurysm is a rare cause of the epistaxis but is a fatal and life-threatening clinical condition if left untreated. Massive epistaxis following head injury should alert the clinician to rule out traumatic cavernous ICA pseudoaneurysm. Traumatic pseudoaneurysm of the cavernous part of the ICA is a challenging clinical entity both in diagnosis and treatment. This clinical diagnosis may be suspected in case of patient with history of head injury, massive recurrent epistaxis and delayed onset of blindness. Massive epistaxis after head trauma should alert the clinician for possible cavernous ICA pseudoaneurysm. Carotid angiography confirms the site of pseudoaneurysm. The treatment options are endovascular stent and coil embolization, arterial balloon occlusion and surgical trapping. Timely diagnosis and treatment of this condition give a favorable outcome. In this review article, we discuss the epidemiology, etiopathology, clinical presentations, investigations and current treatment of the traumatic cavernous ICA pseudoaneurysm.
Near-Fatal Epistaxis From Traumatic Giant Carotid Artery Pseudoaneurysm: A Case Report
Background: Traumatic carotid pseudoaneurysms are a rare cause of intractable recurrent epistaxis following a head trauma that is usually treated after a delay by days or even months. Their management includes various options, surgical or endovascular, depending on the clinical situation and the angiographic findings in the patient, with a preference in the later years toward endovascular management. Case Presentation: We present a case of an 18-year-old male patient suffering from recurrent intractable epistaxis. Weeks after a major head trauma, the patient presented to us in a lifethreatening situation with near-fatal epistaxis due to a traumatic giant carotid pseudoaneurysm in the cavernous segment. The patient was managed by parent artery occlusion that was unsuccessful and which led to recurrence of the epistaxis with a near-fatal outcome. Conclusions: Traumatic carotid pseudoaneurysms are a fatal condition that requires management on an emergent basis with a mortality rate ranging from 30% to 50% in nontreated cases in the literature. We present this case as an example of the severity of the condition and to point out that these lesions should not be managed as traditional carotid cavernous aneurysms but should have a distinct nature of their own.
Intractable Epistaxis Secondary to Traumatic Pseudoaneurysm of Internal Carotid Artery
An International Journal Clinical Rhinology
Aim and objective: A rare presentation of intractable massive recurrent epistaxis diagnosed and managed. Background: Traumatic intracranial pesudoaneurysm is a rare complication of blunt trauma. Intracranial internal carotid artery pseudoaneurysm may rupture leading to delayed onset, massive, recurrent epistaxis, which requires an emergency intervention. Case description: Here, we present a case of recurrent massive intractable epistaxis due to a sphenoidal prolapse of supraclinoid part of right internal carotid artery, presenting as a pseudoaneurysm, secondary to a post-traumatic fracture dehiscence of roof of sphenoid, diagnosed with the help of a computed tomography angiography. The patient was treated successfully with a primary endovascular coiling. Conclusion: Intractable epistaxis due to a post-traumatic pseudoaneurysm is quite rare and can be fatal and hence need to be considered in the differential diagnosis of massive recurrent uncontrollable epistaxis and treated at the earliest. Clinical significance: The reach of presentations of such rare cases should be broadened as these are difficult to be diagnosed and managed. Inadequate and untimely diagnosis and management of such cases can cost the life of the patients.
International journal of otolaryngology and head & neck surgery, 2024
Internal carotid artery (ICA) aneurysms are an unusual but serious cause of epistaxis. This epistaxis is massive and sometimes uncontrollable threatening the vital prognosis of patients. We report the case of a 16-year-old adolescent received in emergency with severe bilateral epistaxis, asthenia and grade-3 left exophthalmos. In his history, the subject had been the victim of an assault six months before consultation. He had received blows on the cephalic extremity with light but repeated epistaxis. The treatment consisted to blood products transfusion and local compression by sterile gazes. An ICA aneurysm in sphenoid sinus has been confirmed in a craniofacial CT scan coupled to vascular opacification. Although the ICA has a variable course in contact with the sphenoid sinus, massive epistaxis would be the consequence of a pronounced dehiscence of the ICA in the sphenoid sinus, particularly in a traumatic context. In front of this type of epistaxis in our context, general practitioners must be able to suspect a ruptured ICA aneurysm in the presence of exophthalmos and a notion of old or recent cranio-encephalic injury. Additionally, due to the high morbidity and mortality of this condition, a monitoring algorithm is necessary for patients with head trauma to facilitate early detection.
Background: Pseudoaneurysm of the cavernous internal carotid artery (ICA) is an uncommon clinical incidence. This may cause massive epistaxis and pose a life‑threatening situation for patient. Aim: The aim of this study to acquaint the clinicians with this rare cause of the massive epistaxis due to posttraumatic pseudoaneurysm of the cavernous ICA. This study evaluates the details of patient’s profile including presenting symptoms, investigation, treatment, and outcomes. Materials and Methods: Data of seven patients with cavernous ICA pseudoaneurysm presenting with epistaxis from March 2018 to April 2020 were retrospectively reviewed. Results: The age range of the patients was from 22 to 64 years. Duration of head trauma to the epistaxis ranged from 1 month to 4 months. All had history of head trauma. All were managed by endovascular coil embolization. Conclusion: Cavernous ICA pseudoaneurysm can cause life‑threatening epistaxis. Patients present with severe epistaxis and history of head trauma should be thought for traumatic pseudoaneurysm of cavernous ICA. Endovascular coil embolization of the pseudoaneurysm is an important option for effective treatment.
A Rare Cause of Recurrent Massive Epistaxis: Post-traumatic Cavernous Carotid Artery Pseudoaneurysm
2021
carotid artery is a rare but serious condition. It can give symptoms according to the size of the pseudoaneurysm and the structures it is related to. Particularly pseudoaneurysms in the cavernous segment of the internal carotid artery can cause cranial nerve compression, leading to symptoms and signs such as visual loss.1 However, in the literature massive epistaxis due to cavernous carotid pseudoaneurysm have been reported.2-4 Although epistaxis is one of the most common otorhinolaryngology emergencies, head trauma related epistaxis occupies less than 5% of all etiological factors.5 Nevertheless delayed recurrent or massive epistaxis, especially after head trauma, can be an alarm symptom in terms of pseudoaneurysms in large arteries.
Journal of Nepal Medical Association, 2022
Epistaxis is a common otorhinolaryngology emergency. There are several treatment modalities for epistaxis, but bleeding from the internal carotid artery necessitates a particular treatment technique. We report a case of a 22-years old man who presented to us recurrent episodes of epistaxis and blurry vision in the right eye for one month. The patient had undergone maxillo-facial surgery following a road traffic accident one year back. Bleeding episodes were occasionally severe with blood loss of up to 800 to 1000ml. These episodes were managed conservatively with posterior nasal packing and frequent blood transfusions. A computed tomography-angiography revealed a pseudoaneurysm arising from the cavernous segment of the right internal carotid artery which was managed successfully by embolization of the aneurysm sac with coils. Despite the rarity of internal carotid artery pseudoaneurysm in individuals with a history of trauma, doctors must be aware of the possibility. Timely identif...
Interventional Neuroradiology, 2017
Introduction Blunt head trauma can injure the cavernous segment of the internal carotid artery (ICA). This may result in a carotid cavernous fistula (CCF). Rarely, a traumatic aneurysm may bleed medially causing massive epistaxis. Case presentation We present two cases of traumatic intracavernous carotid pseudoaneurysms with delayed massive epistaxis. The patients were managed with endovascular treatment involving coil embolization with parent vessel sparing and detachable balloon occlusion with carotid sacrifice. Early clinical outcome was good in both patients. Wherever possible, the CARE1 guidelines were followed in the reporting. Conclusion These cases illustrate the delayed nature of traumatic aneurysms and the need for a high index of suspicion in the presence of skull base fractures. The use of endovascular detachable balloon occlusion and coil embolization treatment with parent vessel preservation is shown.
Turkish neurosurgery, 2013
The current study aims to explore the diagnosis and treatment of traumatic internal carotid artery pseudoaneurysm (TICAP) primarily manifested by repeated epistaxis. Clinical data from 31 patients suffering from repeated epistaxis after trauma were retrospectively analyzed. All patients were diagnosed definitely with pseudoaneurysm at the internal carotid cavernous sinus segment by digital subtract angiography (DSA). Endovascular interventional therapy was performed for all the patients. 20 patients received direct occlusion of the parent artery by embolization with detachable balloons and the rest received covered stent implantation to cover the parent arterial tear. No death occurred. Epistaxis did not recur after operation. DSA is the gold standard for TICAP diagnosis. Endovascular interventional therapy is the treatment of choice for TICAP. Compared with internal carotid artery occlusion with balloons, covered stent implantation is a more valuable endovascular intervention method.
Arquivos de Neuro-Psiquiatria, 2008
Vascular lesions can be serious complications resulting of blunt or penetrating trauma 1,2 . Internal carotid artery lesion is one of most serious and relatively frequent in all mechanisms of craniofacial trauma. Several clinical manifestations can occur as central neurologic and cranial nerves deficits as well as several degrees of bleeding (from mild symptomatic to fatal). Recurrent and massive epistaxis can occur after trauma due to pseudaoneurysms of the external and internal carotid artery (ICA) 3,4 . Considering its life-threatening course, the assisting physician has a relatively narrow time to detect and treat these lesions.