INTRACAVERNOUS CAROTID PSEUDOANEURYSM AFTER BLUNT TRAUMA - CASE-REPORT AND DISCUSSION

Epistaxis following blunt facial trauma is usually self-limited and ar ises from the nasal mucosa, sphenopalatine, or anterior ethmoid arteri es. Pseudoaneurysm of the intracavernous carotid artery (ICCA) occurs rarely with penetrating facial trauma, but is even more rare following blunt trauma. Rupture carries a greater than 50% mortality. Because r upture usually occurs after several episodes of epistaxis, recognition of subtle historic and physical findings is paramount to optimal mana gement. Once suspicion is raised, definitive diagnosis and treatment i s best accomplished with cerebral arteriogram and trapping of the pseu doaneurysm. We have noted that rupture may be precipitated by angiogra phy, and, therefore, we advocate availability of emergent and definiti ve treatment equipment and personnel prior to performing cerebral arte riography. This should include an otolaryngologist, an interventional radiologist, and a neurosurgeon. A case of ICCA pseudoaneurysm is pres ented, and the key historic factors are discussed. Radiographic diagno sis and management options are discussed. (C) 1994 John Wiley & Sons, Inc.