Massive epistaxis from a thrombosed intracavernous internal carotid artery aneurysm 2 years after the initial diagnosis--case report.
A 77-year-old woman presented with a rare case of nontraumatic intracavernous internal carotid artery (ICA) aneurysm causing epistaxis. The thrombosed aneurysm was discovered incidentally, and was not treated. However, she suffered massive nasal bleeding 22 months after the initial diagnosis. The lesion was successfully treated by endovascular coil embolization. The present case shows that thrombosed intracavernous ICA aneurysm may still carry the risk of rupture. Radiological evidence of erosion of the sphenoid sinus wall and repeated minor bleeding may be important predicting signs for massive nasal bleeding. Parent artery occlusion including the aneurysm may be the best treatment for intracavernous ICA aneurysms if sufficient collateral blood flow to the territory of the affected ICA is expected.
Nomura
Motohiro
M
Department of Neurosurgery, Yokohama Sakae Kyosai Hospital, Yokohama, Kanagawa. nomura413jp@yahoo.co.jp
Shima
Hiroshi
H
Sugihara
Takahiro
T
Fukui
Issei
I
Kitamura
Yoshihisa
Y
D000368:Aged; D002341:Carotid Artery Thrombosis / Q000473:pathology* / Q000503:physiopathology; D002343:Carotid Artery, Internal / Q000000981:diagnostic imaging / Q000473:pathology; D020215:Carotid Artery, Internal, Dissection / Q000150:complications* / Q000473:pathology* / Q000628:therapy; D020216:Carotid-Cavernous Sinus Fistula / Q000150:complications* / Q000209:etiology / Q000473:pathology*; D002426:Cavernous Sinus / Q000000981:diagnostic imaging / Q000473:pathology; D002533:Cerebral Angiography; D004621:Embolization, Therapeutic / Q000295:instrumentation / Q000379:methods; D004632:Emergency Medical Services / Q000379:methods; D004844:Epistaxis / Q000209:etiology*; D005260:Female; D006801:Humans; D002532:Intracranial Aneurysm / Q000150:complications / Q000473:pathology / Q000628:therapy; D008279:Magnetic Resonance Imaging; D009296:Nasal Cavity / Q000000981:diagnostic imaging / Q000473:pathology; D019736:Prostheses and Implants / Q000592:standards; D019919:Prosthesis Implantation / Q000379:methods; D013101:Sphenoid Sinus / Q000000981:diagnostic imaging / Q000473:pathology; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome