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  • Title: [Dissecting Internal Carotid Aneurysm Causing Epistaxis:A Case Report].
    Author: Kino H, Tsuruta W, Ito Y, Takigawa T, Shiigai M, Marushima A, Nakai Y, Yamamoto T, Matsumura A.
    Journal: No Shinkei Geka; 2018 Sep; 46(9):789-795. PubMed ID: 30262683.
    Abstract:
    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.
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