We describe 3 patients who developed infectious aneurysms of the cavernous
carotid artery. The aneurysms were due to sphenoidal sinusitis in two patie
nts and due to endocarditis in one. The acute and septic onset of the caver
nous sinus syndrome, suggested thrombophlebitis of the cavernous sinus in a
il 3 patients. The diagnosis was established by magnetic resonance imaging
and magnetic resonance angiography. Therapeutic internal carotid artery occ
lusion was indicated for a fissuration of their aneurysm manifested (n = 3)
by an episode of epistaxis (n = 2) and blood in sphenoid sinus (depicted b
y MRI) in one case. We discuss the pathophysiology and management of bacter
ial aneurysms of the cavernous carotid artery. Close clinical and imaging f
ollow-up should be performed for patients under antibiotherapy. Selective a
ngiography with therapeutic occlusion of the carotid artery is discussed in
patients with persistence of symptoms or if clinical findings are suggesti
ve of fissuration or if aneurysmal sac diameter increases on follow-up imag
ing studies.