The ætiology and Treatment of Epistaxis: Based on a Review of 200 Cases

Evans, John

doi:10.1017/s0022215100059193

Cited by 17 publications

(3 citation statements)

References 5 publications

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“…Evan et al found trauma as the underlying cause of severe epistaxis in 3 of 200 patients [13]. If in addition to repeated massive epistaxis and unilateral visual loss a fracture of the cranial base is also pre- [3,4,8].…”

Section: Discussionmentioning

confidence: 99%

False aneurysms of the intracavernous carotid artery — Report of 7 cases

et al. 1997

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We present 7 cases of false intracavernous carotid artery aneurysms. Four occurred after trauma and three were caused iatrogenically. Two of the latter occurred in patients with pituitary adenomas, one after transsphenoidal microsurgery and the other after yttrium [YI90] seed implantation into the sella. The third iatrogenic aneurysm was seen shortly after transcavernous tumour surgery. In five of our seven patients massive, delayed, life-threatening epistaxis was the leading symptom. All traumatic cases were associated with immediate unilateral blindness or blurred vision and with skull base fractures. One of these had a concomitant carotid cavernous fistula. Treatment of choice of our 5 recent cases was permanent balloon occlusion of the intracavernous carotid artery at the level of the lesion. Collateral circulation was evaluated prior to definitive carotid occlusion using a balloon test occlusion. During the balloon test adequate collateral circulation was defined as symmetric angiographic filling of both hemispheres. Awake patients were neurologically examined continuously. In unconscious patients transcranial Doppler sonography, electroencephalographic and somatosensory evoked potential monitoring was used in addition. Intra-operative heparin administration was not reversed with protamin. A postoperative continuous heparin infusion was not found necessary. In our two early cases this technique was not available: In the first case we accomplished aneurysm occlusion by a surgically introduced Fogarty balloon catheter. Our second patient needed surgical trapping of the involved carotid after early unsuccessful attempts of selective aneurysm occlusion. After treatment no further epistaxis occurred. Follow-up angiography showed persistent aneurysm occlusion. The results were excellent in 5 cases and good in 1 case. One patient with bilateral lesions suffered a stroke after occlusion of the second, remaining carotid artery, despite functioning bilateral extra-intracranial bypasses. Four years later there is a mild dysphasia still present in this patient. The mean follow-up time was 75.6 months.

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Section: Discussionmentioning

confidence: 99%

False aneurysms of the intracavernous carotid artery — Report of 7 cases

et al. 1997

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“…Although the test can not completely exclude the possibility of subsequent hemispheric ischemia, some centers couple the test with electroencephalogram (EEG) monitoring or indirect tests such as ophthalmoplethysmography to improve sensitivity.I9 In addition, the University of Pittsburgh has monitored patients with Xenon CT scanning to~uantify cerebral blood flow during balloon occlusion. 2 If a patient fails the test of temporary balloon occlusion, an extracranial-intracranial bypass graft is essential before permanent ICA occlusion to protect the ipsilateral cerebral hemisphere from ischemia. A bypass from the superficial temporal artery to the middle cerebral artery is often performed when marginal cross flow is present.…”

Section: Discussionmentioning

confidence: 99%

Nontraumatic Carotid-Ophthalmic Aneurysm Presenting as Recurrent Epistaxis

Kotton

Itani

1995

American Journal of Rhinology

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Recurrent epistaxis can be a rare presentation of ruptured internal carotid artery aneurysm. Although primarily a neurosurgical problem, these cases may be seen initially by the otolaryngologist, as the aneurysm erodes through the thin adjacent sphenoid sinus wall and ruptures, producing epistaxis. In most cases these aneurysms are traumatic in origin. We present the first cited case of a nontraumatic internal carotid aneurysm, arising from the origin of the ophthalmic artery, which presented as intermittent epistaxis from the sphenoid sinus. We suggest that aneurysmal rupture be considered in the differential diagnosis of all cases of epistaxis from the sphenoid sinus. Nasal endoscopy and CT scan of the paranasal sinuses in nonemergent cases is valuable in localizing the source of the bleed. Furthermore, preoperative angiography is essential in making the diagnosis of aneurysm and avoiding fatal torrential hemorrhage caused by nasal surgery. Once the diagnosis is made, the definitive treatment is surgical or intravascular trapping of the aneurysm. (American Journal of Rhinology 9:9-13, 1995)

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“…This was found to be an inconstant feature of all groups and was not considered to be a prime aetiological factor. Evans (1962) in his survey of epistaxis was also of the opinion that hypertension rarely produced epistaxis in the absence of local nasal disease.…”

Section: Uraemic Epistaxismentioning

confidence: 99%

Otolaryngeal Problems Arising During the Management of Severe Renal Failure

Beaney¹

1964

J. Laryngol. Otol.

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The ætiology and Treatment of Epistaxis: Based on a Review of 200 Cases

Cited by 17 publications

References 5 publications

False aneurysms of the intracavernous carotid artery — Report of 7 cases

False aneurysms of the intracavernous carotid artery — Report of 7 cases

Nontraumatic Carotid-Ophthalmic Aneurysm Presenting as Recurrent Epistaxis

Otolaryngeal Problems Arising During the Management of Severe Renal Failure

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