Post traumatic pseudo-aneurysm of carotid artery presenting as massive oropharyngeal bleed with shock and hemiparesis

Abstract

Background : Aneurysm in the extracranial segment of internal carotid artery is extremely rare in the pediatric age group. They can assume large size and have catastrophic complications of thromboembolism and hemorrhage. We present a 12 year old child with recurrent oropharyngeal hemorrhage leading to massive hematemesis and shock. A distal embolism causing malignant ipsilateral cerebral infarct further complicated the management options. He was treated with an emergency placement of stent within the artery to exclude the flow in the pseudo aneurysm. A right decompressive craniectomy was performed to control the raised intra-cranial pressure secondary to malignant cerebral infarction. The tentorial herniation was relieved in the follow up CT scan of the brain and the child made progressive recovery with residual paralysis of the left side. Aim of our case report is to increase awareness and inclusion of this rare pathology in the differential diagnosis of oropharyngeal hemorrhage which would facilitate the early diagnosis and prevent devastating complications.