激しい鼻出血を来した外傷性偽性内頸動脈瘤の1例

Massive Epistaxis due to Traumatic Internal Carotid Artery Pseudoaneurysm：A Case Report

Ⅰ．はじめに

　頭部外傷後の鼻出血はよくみられる症状であり，通常容易に止血可能である．稀に止血が困難な症例が存在し，その原因として内頸動脈の偽性動脈瘤が報告されている．今回われわれは，外傷による内頸動脈の偽性動脈瘤が慢性期に破裂し，危うく致死的多量出血となりかけた症例を提示する．

　We present a case of traumatic pseudoaneurysm of the internal carotid artery (ICA) accompanied by skull base fracture, which was treated by endovascular trapping of the internal carotid artery. A 70-year-old woman met with a traffic accident and was admitted to our institution with epistaxis and accomapanied with shock. Angiography on day 2 showed carotid-cavernous fistula. The patient had no eye symptom and was treated conservatively. A second angiography, two weeks aftrer the trauma, revealed development of a pseudoaneurysm on the C3-4 portion. We attempted balloon test occlusion (BTO) of the right internal carotid artery, and if torelated, the ICA may have been occluded. The day before BTO, she rebleed massively. Endovascular trapping of the ICA was performed. Although epistaxis was controlled completely, she suffered left hemiparesis due to an embolism during the procedure. Epistaxis from a traumatic aneurysm of the internal carotid artery may be fatal and emergency occlusion is proposed.