EPISTAXIS ORIGINATING FROM TRAUMATIC PSEUDOANEURYSM OF THE INTERNAL CAROTID-ARTERY - DIAGNOSIS AND ENDOVASCULAR THERAPY

Posttraumatic pseudoaneurysm of the internal carotid artery (ICA) is a n uncommon but potentially fatal cause of epistaxis. Because the onset of delayed bleeding from the time of injury is variable, prompt diagn osis of cavernous ICA pseudoaneurysm is often a clinical challenge. Th e relative urgency to evaluate for this disease is highlighted by the morbid nature of this entity. Optimal management demands rapid recogni tion and treatment to give the best functional outcome. The authors pr esent a case series of six patients with skull base ICA pseudoaneurysm . A unifying feature in the majority of patients is the development of delayed, massive epistaxis. The time course for presentation of delay ed life-threatening epistaxis ranged from 5 days to 9 weeks. Two patie nts exhibited the classic triad of unilateral blindness, orbital fract ures, and massive epistaxis. AU. patients requiring intervention were successfully treated with endovascular embolization techniques that in cluded detachable balloons and coils. The clinical and radiologic find ings in this case series are presented. The relevant anatomy, diagnosi s, and treatment of traumatic ICA pseudoaneurysm are reviewed. A conte mporary treatment strategy is proposed.