大量鼻出血をきたした外傷性内頸動脈動脈瘤—1例報告と文献的考察

MASSIVE EPISTAXIS FROM THE TRAUMATIC ANEURYSM OF THE INTERNAL CAROTID ARTERY WITHIN THE CAVERNOUS PORTION:Report of A Case with Review of Literature

Ｉ．はじめに

　第1線の救急病院において，頭部顔面外傷による鼻出血の患者に遭遇することは日常茶飯事のことである。それらは，おおむね止血が容易であり鼻出血が致死的になることは，まずあり得ないのが普通である。

　しかしながら、1870年Delens^10）の報告以来、数数の文献が指摘するように頭部外傷後に致死的な大量鼻出血をきたす患者のいることも又事実である。即ち，外傷後に発生したcavernous portionの内頸動脈動脈瘤の破裂による鼻出血の場合であり，比較的稀なものとされている。

Massive epistaxis from the traumatic aneurysm of the internal carotid artery is rare.

The case reported here was a man aged 18, suffered from a traffic accident. On the 10th day following the injury, he complained of double and blurred vision on the right. Reduction in visual acuity with ocular palsy was progressively ag-gravated. He was discharged from another hospital without cerebral angiography. The patient was brought to our hospital 10 weeks after the incident, because of massive bleeding from the nose and mouth. A right serial carotid angiogram showed a large saccular aneurysm of the internal carotid artery arising from the cavernous portion and extending to the sphenoidal sinus. Extravasa-tion of the contrast medium was demonstrated be-tween the sphenoidal sinus and nasopharyngeal space.

Despite intensive therapy, the patient expired within 1 hour after admission.

In reference to literature, we discussed the clinical and pathological features of the traumatic aneurysm of the internal carotid artery within the cavernous portion.