Two cases of massive recurrent epistaxis caused by internal carotid artery pseudoaneurysm treated with endovascular embolization

Abstract

Appropriate treatment of recurrent epistaxis is important. We experienced two cases of massive and recurrent epistaxis caused by a pseudoaneurysm of the internal carotid artery. The two cases involved a 65-year-old female with no notable medical history and a 68-year-old male who had undergone transsphenoidal surgery for a pituitary adenoma 10 years prior, followed by Gamma Knife therapy. Both patients experienced massive epistaxis and were transported to a local emergency center. The patients were referred to our university hospital for multidisciplinary treatment after subsequent imaging studies revealed pseudoaneurysms of the internal carotid artery. Neurosurgeons stopped the bleeding by endovascular embolization. It is important to keep in mind that internal carotid pseudoaneurysms can cause repeated episodes of massive epistaxis. Contrast-enhanced CT should be promptly performed if suspected.