Near-fatal epistaxis from traumatic giant carotid artery pseudoaneurysm: A case report

BACKGROUND: Traumatic carotid pseudoaneurysms are a rare cause of intractable recurrent epistaxis following a head trauma that is usually treated after a delay by days or even months. Their management includes various options, surgical or endovascular, depending on the clinical situation and the angiographic findings in the patient, with a preference in the later years toward endovascular management. CASE PRESENTATION: We present a case of an 18-year-old male patient suffering from recurrent intractable epistaxis. Weeks after a major head trauma, the patient presented to us in a life-threatening situation with near-fatal epistaxis due to a traumatic giant carotid pseudoaneurysm in the cavernous segment. The patient was managed by parent artery occlusion that was unsuccessful and which led to recurrence of the epistaxis with a near-fatal outcome. CONCLUSIONS: Traumatic carotid pseudoaneurysms are a fatal condition that requires management on an emergent basis with a mortality rate ranging from 30% to 50% in nontreated cases in the literature. We present this case as an example of the severity of the condition and to point out that these lesions should not be managed as traditional carotid cavernous aneurysms but should have a distinct nature of their own.