Abstract EPISTAXIS is a common clinical problem and is rarely serious in its intensity. Conservative estimates indicate that about 90% of all nose bleeds occur in the capillary bed of the septum, known as Keisselbach's area. Rarely, severe epistaxis may occur from damage to the sphenopalatine artery in the posterior nares. Traumatic aneurysms of the internal carotid artery presenting with massive epistaxis are indeed rarely encountered. This report presents a case of a traumatic aneurysm of the internal carotid artery eroding into the eustachian tube, giving rise to repeated severe bleeding episodes, and ending fatally. A number of reports of aneurysms eroding into the sphenoid sinus have been made.1-6 Only one other report of bleeding through the eustachian tube has been found in the world literature.7 The number of head injuries from auto accidents alone suggests that this type of injury may not be as uncommon as this report References 1. Birley, L., and Trotter, W. Traumatic Aneurysm of the Intracranial Portion of the Internal Carotid Artery , Brain 51:184-208, 1928.Crossref 2. Brihaye, J.; Mage, J.; and Verriest, G.: Aneurysme Traumatique de la carotide interne dans sa portion supracliniodienne , Acta Neurol Belg 54:411-438, 1954. 3. Maurr, J.; Mills, M.; and German, W.: Triad of Unilateral Blindness, Orbital Fractures, and Massive Epistaxis After Head Injury , J Neurosurg 18:837-840, 1961.Crossref 4. Seftel, D.; Kolson, H.; and Gordon, B.: Ruptured Intracranial Carotid Artery Aneurysm With Fatal Epistaxis , AMA Arch Otolaryng 70:52-60, 1959.Crossref 5. Araki, C., et al: Traumatic Aneurysm of the Intracranial Extradural Portion of the Internal Carotid Artery , J Neurosurg 23:64-67, 1965.Crossref 6. Wemple, J., et al: Extracranial Carotid Aneurysms: Four Cases , J Neurosurg 24:667-671, 1966.Crossref 7. Rousseau, F., and Spillman, J.: Deux cas d'epistaxis incoercibles avec cecite homolaterale par lesion de la carotide interne intracranienne apris chute, sur la tete , Ann Otolaryng 68:461-465, 1951. 8. Voris, H., and Basile, J.: Recurrent Epistaxis From Aneurysm of the Internal Carotid Artery , J Neurosurg 18:841-842, 1961.Crossref 9. Weaver, D., et al: Retropharyngeal Hemorrhage From the Carotid Artery , Trans Amer Laryng Assoc 85:222-337, 1964. 10. Hamilton, J., and Falconer, M.: Immediate and Late Results of Surgery in Cases of Saccular Intracranial Aneurysms , J Neurosurg 16:514-541, 1959.Crossref
Archives of Otolaryngology – American Medical Association
Published: Mar 1, 1968
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