Dissecting Internal Carotid Aneurysm Causing Epistaxis:A Case Report
Kino, H.; Tsuruta, W.; Ito, Y.; Takigawa, T.; Shiigai, M.; Marushima, A.; Nakai, Y.; Yamamoto, T.; Matsumura, A.
No Shinkei Geka. Neurological Surgery 46(9): 789-795
2018
ISSN/ISBN: 0301-2603 PMID: 30262683 Document Number: 695332
We report a rare case of a ruptured dissecting internal carotid aneurysm caused epistaxis without a history of trauma or infection. An 89-year-old woman experienced epistaxis and suffered from hemorrhagic shock at her previous hospital. Head computed tomography(CT)images revealed a ruptured internal carotid aneurysm protruding into the Onodi cell, the most posterior ethmoidal sinus, which extends superolaterally to the sphenoid sinus. Cerebral angiography demonstrated a multilobular-shaped dissecting aneurysm with a maximal diameter of 6.7mm at the cavernous portion of the internal carotid artery(ICA). Overlapping stenting was performed to prevent recanalization. However, a fatal subarachnoid hemorrhage occurred 2 days after the procedure due to the progression of the dissection to the intracranial ICA. The anatomical characteristics of the ethmoidal sinus could be associated with the occurrence of epistaxis. A ruptured small ICA aneurysm with an Onodi cell might cause epistaxis without a history of trauma or infection.