The primary treatment of nasopharyngeal carcinoma (NPC) has been external radiotherapy. Rupture of an internal carotid artery (ICA) pseudoaneurysm is a rare complication of irradiation therapy for a nasopharyngeal carcinoma. A 78 years old man had a history of NPC treated with radiotherapy in 1993. He was admitted to the hospital because of epistaxis. Angiography showed an ICA pseudoaneurysm pointing medially to the nasopharynx. Coil embolization of the ICA was performed, but cerebral infarction occurred. Internal carotid artery (ICA) pseudoaneurysms are an uncommon but potentially lethal condition. Angiography is the mainstay of diagnosis of the aneurysm and planning the embolization of the ICA. We should be more aware of this complication in NPC patients.

Based on the observation of 65 patients admitted for epistaxis from July 2000 to June 2007, we noted a higher frequency in men than women male/female ratio about 2 to 1 , a higher incidence among the middle aged and olderly than in younger patients, and a higher epistaxis frequency in winter. Among subjects, 25 38.5% had bleeding in Kisselbach's area, 13 20% in the inferior turbinate or meatus, 7 10.8% in the middle turbinate or meatus, 5 7.7% in the olfactory cleft, 1 1.5% in the bottom of the common nasal meatus, 1 1.5% in the posterior nasal septum, and 13 20% at unidentifiable sites. All were treated with gauze packing. Ten patients 15.4% were treated with postnasal packing using Belloq's tampon or epistaxis balloon. None underwent surgical arterial ligation or arterial embolization. Complications seen in 51 78.5% included hypertension, heart disease, liver disease, diabetic mellitus, postoperative heart disease artificial valve replacement , and chronic renal failure. Anticoagulation therapy was conducted for 18 27.7% and wafarin therapy for 11 16.9%. Epistaxis that complicates warfarin therapy is becoming increasingly common. Prothrombin time international normalized ratio : INR was measured routinely and ranged from 1.3 to 3.8, averaging 2.23. In all patients but one, warfarin was stopped temporarily until epistaxis was controlled. No thromboembolic complications occurred. When epistaxis is encountered in the elderly, it thus becomes to consider both local treatment for epistaxis and the possibility of systemic disease.

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