Delayed massive epistaxis from traumatic cavernous carotid false aneurysms: A report of two unusual cases (original) (raw)
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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.
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.
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.
Traumatic pseudoaneurysm of the cavernous carotid: a lethal complication of craniofacial trauma
Journal of Surgical Case Reports
Pseudoaneurysm of the cavernous carotid artery is a rare, yet life-threatening complication of craniofacial trauma. It may well present itself with delayed massive epistaxis up to several months after the initial insult. Early recognition and prompt treatment are the key in management and a high index of clinical suspicion is always required. In this article, we report a patient with a penetrating head injury who developed delayed epistaxis along with unilateral abducent and partial oculomotor palsy. Urgent diagnostic carotid angiography was undertaken, followed by endovascular coiling that resulted in no recurrence for a year of follow-up.
Neurosciences (Riyadh, Saudi Arabia), 2016
Traumatic intracranial pseudoaneurysm is a rare complication of blunt trauma. It is even more rare when it presents as epistaxis. Massive epistaxis of a ruptured intracranial internal carotid artery pseudoaneurysm is a major cause of mortality, which requires emergency intervention. We report a case of traumatic intracranial internal carotid artery pseudoaneurysm secondary to skull base fracture, which presented with delayed onset of epistaxis. This was successfully treated by primary endovascular coil embolization. We discuss endovascular treatment options and review the literature.
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.
Traumatic Internal Carotid Artery Aneurysm and Massive Epistaxis
Anz Journal of Surgery, 1989
A case of traumatic internal carotid artery aneurysm (ICAA) is described. Although rare, the Occurrence of rupture or traumatic ICAA with epistaxis has a high mortality. Successful management requires an awareness of the entity. prompt recognition. and aggressive first aid procedures. Definitive treatment involves trapping of the internal carotid artery either by a direct approach, or by balloon embolization.
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, 2015
This paper is a case report of a young patient after a major head trauma causing multiple skull base fractures. The trauma occasioned pseudoaneurysm (PSA) from intracavernous C4 segment of left internal carotid artery (ICA) protruding in the sphenoidal sinus. After two months, two episodes of massive epistaxis occurred. Consequently, the post-traumatic PSA was treated, after carotid occlusion test, with flow-diverter stent positioning. A computed tomography angiography study performed in the following days showed complete resolution of the post-traumatic PSA lesion and ICA patency.