Cervical internal carotid Artery pseudoaneurysm complicating malignant otitis externa: First case report

Abstract

Pseudoaneurysm of the internal carotid artery (ICA) is a rare complication of head and neck infections. To date, three cases of petrous ICA pseudoaneurysm have been described as a complication of otogenic infection, including only one secondary to malignant otitis externa. We present here the first case of cervical ICA pseudoaneurysm as a complication of malignant otitis externa, and stress the importance of timely diagnosis to avoid fatal outcomes.

Malignant otitis externa complicated by multiple cervical-petrous internal carotid artery pseudoaneurysms: a case report

“…Cervical-petrous internal carotid artery pseudoaneurysms can arise from different aetiologies including congenital, trauma, malignancy, radiation therapy, and infection. Cases of ruptured ICA pseudoaneurysm due to otogenic infection are rare with only four cases reported [1][2][3][4] ; these cases were MOE complicated by pseudoaneurysm on only one ICA segment. This is the first reported case of pseudoaneurysm occurring on multiple segments of the ICA with rupture due to MOE, and demonstrates the features that predict development of complex vascular complications of unresolved otogenic infection, the timing of appropriate imaging modalities, and appropriate algorithm and duration of treatments to prevent or rescue a fatal carotid blowout.…”

“…Pseudomonas aeruginosa is the most common causative organism. 1 Conventionally, MOE is classified according to the structural involvement CASE REPORT (Table). 5 In stage II MOE, complications can arise as it invades the temporal bone and surrounding nerve and vascular structures causing multiple cranial nerve palsies and carotid pseudoaneurysms.…”

“…In our patient, the time to diagnosis of MOE was 12 weeks compared with an average of 13 weeks. 1 Because the possible mechanisms of the palsies include contiguous infectious spread or direct compression by the pseudoaneurysm, it is paramount that we recognise the warning signs of pseudoaneurysm and instigate appropriate investigations and treatment (Table).…”

Petrous Internal Carotid Artery Aneurysm: A Systematic Review

“…To direct treatment strategies for cranial nerve palsy due to PAs in the future, we conducted a literature review of previously reported cases 6,7,[9][10][11][12][13][14][15][16]19,20,[24][25] . We searched for all reported case studies and clinical research papers regarding PAs that were published in English.…”

“…In recent years, an increasing number of treatments for PA, such as use of a flow diverter 9,13,14 , have been reported; however, revascularization surgery remains an important strategy 10,15 . Many PA patients are difficult to treat intravascularly, particularly those with infectious diseases 6,16 , ruptures 17 , and pseudoaneurysm 16 . Furthermore, not all treatment strategies are available for all patients as some patients are allergic to contrast agents or metals 18 and some have renal dysfunction.…”