title: Delayed Presentation of an Extracranial Internal Carotid Artery Pseudoaneurysm and Massive Epistaxis Secondary to a Nasal Foreign Body: Case Report and Review of the Literature.
abstract: BACKGROUND
  Epistaxis is a very common medical condition and can often be controlled with conservative measures. Rarely, uncontrolled and life-threatening epistaxis can occur.
  
  
  METHODS
  We present the case of a 58-year-old man who developed delayed, massive epistaxis caused by an extracranial left internal carotid artery pseudoaneurysm caused by an intranasal foreign object without apparent recent trauma. The patient was successfully treated with endovascular stenting of the affected vessel segment.
  
  
  CONCLUSIONS
  Massive epistaxis is a potentially lethal condition. Although the source uncommonly originates from the internal carotid artery, pseudoaneurysm rupture needs to be considered on the differential diagnosis in selected patients. This case illustrates the need for vigilance for the presence of foreign objects and/or vessel injuries in the setting of acute, massive epistaxis. Additionally, we describe treatment options and review the literature.
authors.affiliation: Department of Neurological Surgery, West Virginia University, Morgantown, West Virginia, USA.
authors.forename: Gennadiy A
authors.initials: GA
authors.lastname: Katsevman
authors.affiliation: Department of Neurological Surgery, Indiana University, Indianapolis, Indiana, USA.
authors.forename: John A
authors.initials: JA
authors.lastname: Braca
authors.affiliation: Department of Otolaryngology, Head and Neck Surgery, Loyola University Medical Center, Maywood, Illinois, USA.
authors.forename: Kevin C
authors.initials: KC
authors.lastname: Welch
authors.affiliation: Department of Neurological Surgery, Loyola University Medical Center, Maywood, Illinois, USA. Electronic address: Washley72@yahoo.com.
authors.forename: William W
authors.initials: WW
authors.lastname: Ashley
mesh_terms: D017541:Aneurysm, False / Q000150:complications* / Q000000981:diagnostic imaging / Q000601:surgery; D002343:Carotid Artery, Internal / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery; D004724:Endoscopy; D057510:Endovascular Procedures; D004844:Epistaxis / Q000150:complications* / Q000000981:diagnostic imaging / Q000601:surgery; D005547:Foreign Bodies / Q000150:complications* / Q000000981:diagnostic imaging / Q000601:surgery; D006801:Humans; D018810:Magnetic Resonance Angiography; D008297:Male; D008875:Middle Aged; D015898:Tomography Scanners, X-Ray Computed
keywords: Cervical; Hemorrhage; Internal carotid artery; Nasal cavity; Pseudoaneurysm; Stent