Abstract
Severe projectile epistaxis due to non-traumatic internal carotid artery aneurysms is potentially life threatening but extremely rare, with hardly any report existing in the literature. We present the case of a 21-year old male with a history of recurrent torrential epistaxis associated with headache and dizziness. Catheter angiography revealed two aneurysmal dilatations at the cavernous and supraclinoid segments of the right internal carotid artery.
Highlights
Nontraumatic cavernous internal carotid artery (ICA) aneurysms are a rare cause of epistaxis, with most usually presenting with signs and symptoms of a space-occupying lesion
We report the anesthetic management of a patient with a nontraumatic cavernous ICA aneurysm causing massive recurrent projectile epistaxis who underwent multiple surgeries
CT and catheter angiography revealed two aneurysmal dilatations - the larger situated at the junction of the distal cavernous segment and proximal supraclinoid segment of the right ICA measuring 1.3 × 1.1 × 1.3 cm and a smaller aneurysm in the distal cavernous segment measuring 0.8 × 0.6 × 0.9 cm telescoping into the right sphenoid sinus (Figure 2 and Figure 3)
Summary
Nontraumatic cavernous internal carotid artery (ICA) aneurysms are a rare cause of epistaxis, with most usually presenting with signs and symptoms of a space-occupying lesion. A 21-year old previously healthy male was initially seen with recurrent episodes of epistaxis over a three-month period, that either resolved spontaneously or was adequately controlled by anterior nasal packing (Figure 1) These were associated with headache and dizziness, with the patient denying any visual complaints or any history of major head trauma. Four months after the initial surgery, a recurrence of the projectile epistaxis prompted an emergency admission where a repeat angiogram demonstrated the two aneurysms and short segment stenosis in the distal right common carotid segment possibly due to recanalization (Figure 4). Provisions were made to maintain the patient’s systolic blood pressure within baseline values during carotid ligation He was discharged four days after the procedure without new neurologic complaints. A routine followup angiogram performed four months after the surgery revealed no evidence of aneurysm filling or right common carotid recanalization (Figure 6)
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