Bilateral Nontraumatic Intracavernous Internal Carotid Aneurysms presenting with Massive Epistaxis

Case Report

Abstract

A 68-year-old woman who suddenly developed severe, recurrent epistaxis was found to have bilateral, nontraumatic intracavernous aneurysms. On the right side, a giant aneurysm protruded medially, enlarging the sella turcica. Following emergency ligation of the cervical internal carotid artery under local anesthesia, the bleeding stopped. Subsequently, a right superficial temporal to middle cerebral artery anastomosis was created and the aneurysm was trapped at the C3 portion proximal to the ophthalmic artery.
There have been only eight other reports of ruptured nontraumatic intracavernous aneurysms presenting with massive epistaxis. These cases are reviewed and compared with similar cases in which the aneurysms were traumatic in origin. Diagnostic procedures are also discussed.