Epistaxis from posttraumatic aneurysm of the internal carotid artery

Close metadata

Recommended articles:

Local hemostasis techniques in epistaxis. Russian Rhinology. 2024;(4):308-313

Surgical method for stopping relapsing bleeding from the posterior nasal cavity. Russian Rhinology. 2024;(4):329-332

Neuromodulatory pharmacotherapy individualization in prolonged and chronic consciousness disorders after severe traumatic brain injury. Burdenko's Journal of Neurosurgery. 2024;(3):74-80

Possibilities of using results of head computed tomography in victims with traumatic brain injuries. Forensic Medical Expertise. 2024;(3):24-28

Main mechanisms of secondary ischemic brain damage formation in case of craniocerebral injury. Forensic Medical Expertise. 2024;(3):54-59

Brain injury following child maltreatment syndrome in newborns and young children. Shaken baby syndrome. Burdenko's Journal of Neurosurgery. 2024;(4):5-12

Severe traumatic brain injury with damage to the posterior cranial fossa in a teenager. S.S. Korsakov Journal of Neurology and Psychiatry. 2024;(8):113-117

Growing skull fracture of the orbital roof: case report and literature review. Burdenko's Journal of Neurosurgery. 2024;(5):77-86

Comparative analysis of different types of tampons used after septoplasty, conchotomy of the inferior turbinates. Russian Bulletin of Otorhinolaryngology. 2024;(5):16-22

Glial fibrillary acidic protein: is there a relationship with the course of multiple sclerosis and traumatic brain injury before the onset of multiple sclerosis?. S.S. Korsakov Journal of Neurology and Psychiatry. 2024;(10):80-84

Bleeding from posttraumatic aneurysms of the internal carotid artery presents a real threat to a patient’s life. In a number of cases, posttraumatic aneurysm is followed by the formation of carotid cavernous fistula. This article describes a case of profuse epistaxis in a patient who has sustained serious brain injury. Five weeks after the injury, the patient experienced recurrent profuse epistaxis. When admitted to the ENT unit of the Taganrog Emergency Hospital, the patient was found to have right-sided exophthalmos, chemosis, conjunctival vascular injection, exotropia, restricted eye movement, and right-sided mydriasis. Spiral computed tomography revealed fractures of the anterior and posterior walls of frontal sinuses, the walls of maxillary and sphenoid sinuses, the base of the skull, and pneumocephalus. After intensive infusion therapy, the patient felt better, refused to be further examined and treated in a specialized unit, and he was discharged from hospital. Recurrent epistaxis occurred 2 weeks after discharge. During one of these episodes, the patient died 2 months after the injury.

Keywords:

epistaxis

carotid cavernous fistula

brain injury

epistaxis

carotid cavernous fistula

brain injury

Authors:

Boiko N.V.

Rostov State Medical University, Ministry of Health of Russia, Rostov-on-Don, Russia

Batueva V.A.

City Emergency Hospital, Taganrog, Rostov Region, Russia

List of references:

Rukovodstvo po rinologii. Pod red. Piskunova G, Piskunova S. Moscow: Litterra; 2011. (In Russ.).
Volkov A, Boiko N, Bykova V, Zhdanov V. Further improvement of the methods for the arrest of nasal bleeding. Vestnik otorinolaringologii. 2010;(4):9-12. (In Russ.).
Piskunov S, Elkov I, Kokosha B, Piskunov V, Feoktistov G. Two mortal cases of nasal bleeding from internal carotid artery. Rossiyskaya rinologiya. 2000;(1):40-41. (In Russ.).
Slavsky A, Gavrilov P. A rare case of nasal hemorrhage from the internal carotid artery aneurism. Vestnik otorinolaringologii. 2013;73(2):73-75. (In Russ.).
Fontela PS, Tampieri D, Atkinson JD, Daniel SJ, Teitelbaum J, Shemie SD. Posttraumatic pseudoaneurysm of the intracavernous internal carotid artery presenting with massive epistaxis. Ped Crit Care Med. 2006;7(3):260-262. doi:10.1097/01.pcc.0000216418.01278.5e
6. Ronchetti G, Panciani PP, Cornali C, Mardighian D, Villaret AB, Stefini R, Fontanella MM, Gasparotti R. Ruptured aneurysm in sphenoid sinus: which is the best treatment? Case Rep Neurol. 2013;5(1):1-5. doi:10.1159/000346347.
Mathews SS, Kumar RM, Rupa V. Iatrogenic pseudoaneurysm: a rare complication of sinonasal surgery. Am J Otolaryngol. 2011;32(6):607-610. doi:10.1016/j.amjoto.2010.08.004
Chen Z, Zhang J, Miao H, Niu Y, Feng H, Zhu G. Delayed rupture of iatrogenic cerebral pseudoaneurysms after neurosurgical procedures: report of two cases. Clin Neurol Neurosurg. 2013;115(8):1552-1554. doi:10.1016/j.clineuro.2012.12.024
Wewel J, Mangubat EZ, Munor L. Iatrogenic traumatic intracranial aneurysm after endoscopic sinus surgery. J Clin Neurosci. 2014;21(12):2072-2076. doi:10.1016/j.jocn.2014.05.017
Liang W, Xiaofeng Y, Weiguo L, Wusi Q, Gang S, Xuesheng Z. Traumatic carotid cavernous fistula accompanying basilar skull fracture: a study on the incidence of traumatic carotid cavernous fistula in the patients with basilar skull fracture and the prognostic analysis about traumatic carotid cavernous fistula. J Trauma. 2007;63(5):1014-1020. doi:10.1097/ta.0b013e318154c9fb.
Haffajee MR, Naidoo S. Giant intracavernous internal carotid artery aneurysm with fatal epistaxis. Clin anat. 2003;16(3):277-281. doi:10.1002/ca.10127
Lau WY, Chow CK. Radiation-induced petrous internal carotid artery aneurysm. Ann Otol Rhinol Laryngol. 2005;114(12):939-940. doi:10.1177/000348940511401208
Sugie M, Ihihara K, Nakano I, Kawamura M. Infectious aneurysm of the intracavernous carotid artery occurring concomitantly with sphenoid sinusitis; an autopsy case report. J Neurolog Sci. 2009;278(1-2):115-118. doi:10.1016/j.jns.2008.11.017.
Maldonado-Naranjo A, Kshettry VR, Toth G, Bain M. Non-traumatic superior hypophyseal aneurysm with associated pseudoaneurysm presenting with massive epistaxis. Clin Neurol Neurosurg. 2013;115(10):2251-2253. doi:10.1016/j.clineuro.2013.07.003
Drees P, Eckardt A, Gay RE, Gay S, Huber LC. Mechanisms of disease: molecular insights into aseptic loosening of orthopedic implants. Nat Clin Pract Rheumatol. 2007;3(3):165-171. doi:10.1038/ncprheum0428
Pivetta E, Scapolan M, Pecolo M, Wassermann B, Abu-Rumeileh I, Balestreri L, Borsatti E, Tripodo C, Colombatti A, Spessotto P. MMP-13 stimulates osteoclast differentiation and activation in tumour breast bone metastases. Br Cancer Res. 2011;13(5):R105. doi:10.1186/bcr3047
Rudnev S. Jendovaskuljarnoe lechenie arterial'nyh anevrizm kavernoznogo otdela vnutrennih sonnyh arterij: Avtoref. diss. ... kand. med. nauk. Moscow; 1997. (In Russ.)
Grumann AJ, Boivin-Faure L, Chapot R, Adenis JP, Robert PY. Ophthalmologic outcome of direct and indirect carotid cavernous fistulas. Int Ophthalmol. 2012;32(2):153-159. doi:10.1007/s10792-012-9550-4
Wyrick D, Smith SD, Dassinger MS. Traumatic carotid-cavernous fistula presenting as massive epistaxis. J Ped Surg. 2013;48(4):883-886. doi:10.1016/j.jpedsurg.2013.01.041
Erickson BP, Johnson TE. A 32-year-old man with delayed onset, post-travmatic proptosis and diplopia. J Emer Med. 2014;46(4):475-478. doi:10.1016/j.jemermed.2013.09.015
Miller NR. Diagnosis and management of dural carotid-cavernous sinus fistulas. Neurosurg Focus. 2007;23(5):Е13. doi:10.3171/foc-07/11/e13
Gemmete JJ, Ansari SA, Gandhi DM. Endovascular techniques for treatment of carotid-cavernous fistula. J Neuroophthalmol. 2009;29(1):62-71. doi:10.1097/wno.0b013e3181989fc0.
Nadarajah J, Madhusudhan KS, Yadav AK, Chandrashekhara SH, Kumar A, Gupta AK. MR imaging of cavernous sinus lesions: Pictorial review. J Neurorad. 2015;42(6):305-319. doi:10.1016/j.neurad.2015.04.010.
Cohen JE, Moscovici S, Gomori JM, Eliashar R, Weinberger J, Itshayek E. Selective endovascular embolization for refractory idiopathic epistaxis is a safe and effective therapeutic option: Technique, complications, and outcomes. J Clin Neurosci. 2012;19:687-690. doi:10.1016/j.jocn.2011.08.019.
Rashad S, Hassan T, Aziz W, Marei A. Carotid artery occlusion for the treatment of symptomatic giant carotid aneurysms: a proposal of classification and surgical protocol. Neurosur rev. 2014;37(3):501-511. doi:10.1007/s10143-014-0533-y.
Ambekar S, Madhugiri V, Sharma M, Cuellar H, Nanda A. Evolution of management strategies for cavernous carotid aneurysms: a review. World Neurosurg. 2014;82(6):1077-1085. doi:10.1016/j.wneu.2014.03.042.
Boiko N. Surgical treatment for recurrent nasal bleeding. Rossiyskaya rinologiya. 1999;(2):29-33. (In Russ.).
Wang W, Li YD, Li MH, Tan HQ, Gu BX, Wang J, Zhang PL. Endovascular treatment of posttraumaticdirect carotid-cavernous fistulas: a single-center experience. J Clin Neurosci. 2011;18(1):24-28. doi:10.1016/j.jocn.2010.06.008.
Madan A, Mujic A, Daniels K, Hunn A, Liddell J, Rosenfeld JV. Traumatic carotid-cavernous sinus fistula treated with a covered stent. Report of two cases. J Neurosurg. 2006;104(6):969-973. doi:10.3171/jns.2006.104.6.969.
Oishi A, Miyamoto K, Yoshimura N. Etiology of carotid cavernous fistula in Japanese. Jpn J Ophthalmol. 2009;53(1):40-43. doi:10.1007/s10384-008-0611-1.

Close metadata