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[Dissecting Internal Carotid Aneurysm Causing Epistaxis:A Case Report]
Hiroyoshi Kino1, Wataro Tsuruta, Yoshiro Ito
1Department of Neurosurgery, University of Tsukuba.
No Shinkei Geka. Neurological Surgery
|September 29, 2018
Summary
A rare ruptured internal carotid artery aneurysm caused nosebleeds and shock in an elderly woman. Anatomical proximity to the Onodi cell may explain epistaxis without trauma, though dissection progression led to a fatal outcome.
Area of Science:
- Neurology
- Otolaryngology
- Vascular Surgery
Background:
- Internal carotid artery aneurysms are rare vascular pathologies.
- Epistaxis typically results from local trauma or infection, not spontaneous aneurysm rupture.
Observation:
- An 89-year-old woman presented with epistaxis and hemorrhagic shock.
- Head CT revealed a ruptured internal carotid artery aneurysm protruding into the Onodi cell (posterior ethmoidal sinus).
- Cerebral angiography confirmed a dissecting aneurysm in the cavernous portion of the internal carotid artery.
Findings:
- The aneurysm, measuring 6.7mm, was treated with overlapping stenting.
- Dissection progression to the intracranial internal carotid artery occurred 2 days post-procedure.
- This resulted in a fatal subarachnoid hemorrhage.
Implications:
- The Onodi cell's anatomical relationship may predispose to epistaxis from ruptured internal carotid artery aneurysms.
- This case highlights a rare cause of spontaneous epistaxis and the potential complications of treating such aneurysms.
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