title: Traumatic Anterior Cerebral Artery Pseudoaneurysmal Epistaxis.
abstract: BACKGROUND
  Pseudoaneurysmal epistaxis is a rare but emergent condition. We report a case of traumatic anterior cerebral artery pseudoaneurysmal epistaxis and review the published literature.
  
  
  METHODS
  A 49-year-old man sustained severe head trauma. He was diagnosed with multiple skull bone fractures, left subdural hematoma, subarachnoid hemorrhage, pneumocephalus, and right frontal hematoma. Subdural hematoma evacuation was done at a local hospital. In the following months, he experienced repeated epistaxis that required nasal packing to stop the bleeding. Digital subtraction angiography showed an anterior cerebral artery pseudoaneurysm protruding into the posterior ethmoid sinus. Embolization of the aneurysm was performed with microcoils, and the parent artery was occluded by thrombosis. The patient presented 1 month later with another epistaxis episode. Digital subtraction angiography showed recanalization of the parent artery and recurrence of the aneurysm. The parent artery was occluded for the second time with coils and Onyx embolic agent.
  
  
  CONCLUSIONS
  Pseudoaneurysmal epistaxis is rare, and this is the first report of an anterior cerebral artery pseudoaneurysm that manifested with epistaxis. Endovascular intervention has become the first choice of treatment for this disease. The high recurrence rate is the main disadvantage of endovascular intervention. Aneurysm trapping with bypass surgery is another treatment option.
authors.affiliation: Neurosurgery Department, Qilu Hospital of Shandong University, Jinan, China.
authors.forename: Qing Lin
authors.initials: QL
authors.lastname: Liu
authors.affiliation: Neurosurgery Department, Qilu Hospital of Shandong University, Jinan, China.
authors.forename: Hao
authors.initials: H
authors.lastname: Xue
authors.affiliation: Operating Department, Qilu Hospital of Shandong University, Jinan, China.
authors.forename: Chang Jing
authors.initials: CJ
authors.lastname: Qi
authors.affiliation: Neurosurgery Department, Qilu Hospital of Shandong University, Jinan, China.
authors.forename: Peng
authors.initials: P
authors.lastname: Zhao
authors.affiliation: Neurosurgery Department, Qilu Hospital of Shandong University, Jinan, China. Electronic address: drwangdonghai@163.com.
authors.forename: Dong Hai
authors.initials: DH
authors.lastname: Wang
authors.affiliation: Neurosurgery Department, Qilu Hospital of Shandong University, Jinan, China. Electronic address: doctorligang@126.com.
authors.forename: Gang
authors.initials: G
authors.lastname: Li
mesh_terms: D017541:Aneurysm, False / Q000000981:diagnostic imaging / Q000209:etiology / Q000628:therapy*; D020771:Anterior Cerebral Artery / Q000000981:diagnostic imaging / Q000601:surgery; D002539:Cerebral Arterial Diseases / Q000000981:diagnostic imaging / Q000209:etiology / Q000628:therapy*; D004844:Epistaxis / Q000000981:diagnostic imaging / Q000209:etiology / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009104:Multiple Trauma / Q000150:complications; D012008:Recurrence
keywords: ACA; Epistaxis; Head trauma; Pseudoaneurysm