Pseudoaneurysm of the internal carotid artery presenting with massive (recurrent) epistaxes: a life-threatening complication of craniofacial trauma

Abstract

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.We present two cases of recurrent and massive epistaxis secondary to ICA pseudoaneurysm following blunt and perforating trauma. Evolution was fatal in the first case with delayed treatment and uneventfully in the second which was treated by occlusion of the pseudoaneurysm and ICA via endovascular intervention. CASES Case 1A 22-year-old girl suffered a motor vehicle accident with facial and cranial blunt trauma six months earlier. On admission at another institution, she presented nasal and oral bleeding and normal neurological examination (Glasgow score 15). Admission computed tomography (CT) showed basal orbitofrontal and maxillary fracture and no abnormality in the paranasal sinus (Fig 1). In subsequent days, she developed progressive right eye amaurosis, facial hypoesthesia, and epistaxis. Orbital decompressive surgery was performed. Over the next months she had some recurrent nasal bleeding episodes which were controlled by nasal packing. CT performed 5 months later showed an eroding mass in the sphenoidal sinus with enhanced contrast media inside (Fig 2). Magnetic resonance imaging (MRI) showed a flow void inside the mass, and a pseudoaneurysm was suspected

Near-Fatal Epistaxis From Traumatic Giant Carotid Artery Pseudoaneurysm

“…[1][2][3][4] Pathophysiology of the formation of traumatic carotid pseudoaneurysms is a tear in the wall of the carotid artery, which leads to the formation of a pseudoaneurysm communication with the arterial lumen. The key in their management is early diagnosis and prompt management with exclusion of the psuedoaneurysm from the circulation.…”

“…[1][2][3][4] The etiology is usually blunt head trauma that leads to skull base fracture causing a tear in the cavernous or petrous portions of the carotid artery and pseudoaneurysm formation. [1][2][3][4] The etiology is usually blunt head trauma that leads to skull base fracture causing a tear in the cavernous or petrous portions of the carotid artery and pseudoaneurysm formation.…”

“…Pulsations from this pseudoaneurysm erode the thin bone of the sphenoid and eventually rup-ture in the nasal cavity causing life-threatening epistaxis, which is difficult to diagnose and manage. [1][2][3][4][5][6][7] We present a case of a patient who suffered from near-fatal epistaxis from a traumatic carotid pseudoaneurysm, which was treated surgically. 2,5 Various treatment options are available, both surgical and endovascular.…”

Internal Carotid Artery Pseudoaneurysm As A Rare Complication Of Labor: A Case Report

“…[2] The risk factors for carotid artery pseudoaneurysm are diabetes mellitus, Ehlers-Danlos syndrome type IV, mycotic infection, tonsillitis, pharyngeal abscess, previous radiotherapy to the neck, neck dissection, postoperative staphylococcus aureus infection secondary to accidental pharyngocutaneous fistula, carotid endarterectomy, surgery for malignant carotid body tumor pseudoaneurysm and craniofacial trauma. [3][4][5][6][7][8] Also in Behçet disease pseudoaneurysms of the arterial system -most commonly aorta and pulmonary artery-may be seen. [9] Carotid injury should be strongly considered if; (i) the patient's neurologic symptoms are not explained by the head CT; (ii) monoparesis, hemiparesis, or Horner syndrome; (iii) cervical soft tissue injury; or (iv) mandibular or basilar skull fractures.…”

“…In these cases formation of an arteriovenous fistulae (carotidocavernous if occurs inside the cavernous sinus) or a pseudoaneurysm may develop. [3] …”