[Bacterial intracavernous carotid aneurysm presented as massive epistaxis]

A 55-year-old man was admitted with complaints of headache, diplopia, fever and swelling of the right eyelid. Physical examination revealed low grade fever of 37.6 degrees C, but no evidence of infectious focus was detected. The neurological examination disclosed right abducens nerve palsy. An initial routine blood count showed an increased white blood cell count of 11,800/microliters. The erythrocyte sedimentation rate was 93mm and the C-reactive protein level was 3.6mg/dl. Massive epistaxis and hypovolemic shock developed on the 14th day while the patient was receiving antibiotics (CEZ, CMZ) for a possible intracranial infection. The magnetic resonance angiography of the brain and the cerebral angiography demonstrated an aneurysm within the cavernous sinus, which had not been present on the admission. Since epistaxis was caused by a rupture of the aneurysm, internal carotid artery ligation was done. The signs of inflammation improved as well as patients' symptoms. The improvement while using antibiotics strongly implies that the aneurysm was a result of bacterial infection of the cavernous sinus. There have been no reports of ruptured bacterial intracavernous aneurysms presented with massive epistaxis as this case.