Posttraumatic pseudoaneurysm of the intracavernous internal carotid artery presenting with massive epistaxis.
OBJECTIVE
To report a case of posttraumatic pseudoaneurysm of the intracavernous internal carotid artery presenting with massive epistaxis and to discuss its pathophysiology and management.


METHODS
Case report and literature review.


METHODS
Pediatric intensive care unit in a tertiary-care center.


RESULTS
Twelve days after a motor vehicle accident causing a head injury and facial fractures, this patient presented with massive epistaxis due to a pseudoaneurysm of the intracavernous internal carotid artery . Nasal packing was performed and subsequent angiography demonstrated the vascular lesion that had dissected into the sphenoid sinus. Endovascular stent and coil occlusion of the vascular lesion was performed, and the patient's condition improved without any ischemic or thromboembolic sequelae.


CONCLUSIONS
Posttraumatic aneurysms of the intracavernous internal carotid artery can be associated with delayed and sometimes lethal massive epistaxis. This vascular lesion should be considered in patients with traumatic brain injury presenting with basal skull fractures in the region of the carotid canal or cavernous sinus and/or orbital fractures and compromise of the optical nerves. Knowledge of these risk factors and early diagnosis can minimize the high mortality risk.
Division of Pediatric Critical Care, Montreal Children's Hospital, Montreal, Canada.
Patricia S
PS
Fontela
Donatella
D
Tampieri
Jeffrey D
JD
Atkinson
Sam J
SJ
Daniel
Jeanne
J
Teitelbaum
Sam D
SD
Shemie
D000063:Accidents, Traffic; D000293:Adolescent; D017541:Aneurysm, False / Q000209:etiology* / Q000628:therapy; D002343:Carotid Artery, Internal; D002533:Cerebral Angiography; D004621:Embolization, Therapeutic; D004844:Epistaxis / Q000209:etiology* / Q000628:therapy; D006801:Humans; D008297:Male; D015607:Stents