Post-traumatic Cavernous Carotid Pseudoaneurysm with Delayed Epistaxis

Abstract

Cavernous carotid aneurysms (CCAs) pose considerable dilemmas in management. Delayed post-traumatic epistaxis is a rare presentation of CCA. Clinically, the symptomatic triad of unilateral blindness, orbital fractures, and massive epistaxis is pathognomonic for internal carotid artery (ICA) pseudoaneurysm. The epistaxis is usually profound, intermittent, and life-threatening in nature. As most of these cases are initially seen by a physician, a high index of suspicion is essential during its early identification. Traumatic aneurysms are pseudoaneurysms with a fibrous wall that rupture and cause massive epistaxis resulting from disruption through the sphenoid sinus wall. We report a young adult who presented with the triad and severe anemia four months following head injury. He was treated with ligation of the carotid artery and a high-flow extracranial-intracranial (EC-IC) bypass. In the era of endovascular coiling and flow diverters, EC-IC bypass still has a role in the treatment of complex giant aneurysms with comparable results.

頭蓋底骨折後遅発性に鼻出血を契機に発見された内頸動脈仮性瘤の1例(A case of delayed discovery of a internal carotid artery pseudoaneurysm by nosebleeds after skull base fracture)

“…頭部外傷後に頭蓋底動脈瘤の形成や瘤からの出血を疑う症状として，片側の視覚異常，血管雑音，頭蓋底骨折の存在，繰り返す鼻出血，新規に出現した激しい頭痛，脳神経麻痺，昏迷や昏睡などがあり 4)，内頸動脈仮性動脈瘤の臨床的3徴は片眼失明，視神経管骨折，大量鼻出血と言われている 9)。これら3徴のうち1つでも認めている場合は，視神経管周囲の骨や内頸動脈に外力が加わった可能性が高く，仮性動脈瘤形成のハイリスク症例と考えるべきである。本症例では受傷時から右眼失明，右視神経骨折を認めておりハイリスク症例に位置づけられる。…”

Massive Epistaxis Revealing a Post-Traumatic Aneurysm of the Internal Carotid Artery: A Clinical Case and Review of the Literature

“…Carotid-cavernous aneurysms are a very rare condition, with 2% -9% of intrac- ranial aneurysms and 15% of ICA aneurysms [1]. Traumatic aetiologies are found in 72 to 90% of cases compared to 30% for spontaneous forms [2] [3] [4].…”

Traumatic pseudoaneurysm of the cavernous carotid: a lethal complication of craniofacial trauma

“…Post-traumatic pseudoaneurysm of the cavernous carotid artery (CCA) poses a challenge in its diagnosis and treatment [ 1 ]. It is a rare, yet life-threatening cause of epistaxis and a high index of suspicion is required for rapid recognition and optimum management.…”