Traumatic aneurysms of cavernous internal carotid artery with secondary epistaxis

The syndrome of delayed epistaxis and monocular blindness following nonpenetrating head injury is reviewed. Bleeding results from rupture of a traumatic cavernous internal carotid artery aneurysm into the sphenoid sinus. There were 96 patients with this syndrome found in the literature and another four are added in this report. In 73% of the patients, the cause of the epistaxis was not appreciated until 4 months after the initial episode. No antemortem diagnosis was made in 15% of the patients. More frequent use of carotid angiography in patients with posttraumatic mononuclear blindness and delayed epistaxis might help reduce the reported mortality of 30%.