[Intracranial post-traumatic aneurysm of the internal carotid artery as cause of epistaxis: considerations on 2 cases]

Abstract

Aneurysm of the internal carotid artery is rarely mentioned as a cause of epistaxis. This condition is quite rare but it is important to consider aneurysms in the etiology of epistaxis because of their high mortality rate and since they require management quite different from that of epistaxis of other origins. After arteriosclerosis the most frequent cause of an aneurysm of the internal carotid artery is a closed or penetrating craniofacial trauma injuring the artery. This leads to subsequent aneurysmal dilation of the cavernous and petrous portions of the artery itself. Aneurysms of the cavernous portion of the artery are more frequent. In this location the aneurysm has a close anatomical relationship with the sphenoid sinus as well as the nasal fossae. In the present paper two cases of traumatic intracavernous carotid aneurysms presenting epistaxis are described. In the first case, reported 25 years ago, the diagnosis was made on an autoptic table in young man who died after two severe episodes of massive nasal hemorrhage. The second case involved a 17-year-old man with a severe epistaxis reported one month after a close craniofacial trauma. An intracranial carotid pathology was suspected because of the recurrence of nose-bleeding and the history of reduced visual activity. Therefore angiography was performed which revealed a small aneurysm of the intracavernous segment of the left internal carotid artery. Subsequently, an endovascular balloon embolization of the aneurysm was successful, preserving the parent artery. The importance of considering aneurysms in the differential diagnosis of massive epistaxis is emphasized.