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Massive Epistaxis from Internal Carotid Pseudoaneurysm during Acute Ischemic Stroke in a Patient with Nasopharyngeal Carcinoma.

PURPOSE
Carotid blowout syndrome due to rupture of internal carotid artery pseudoaneurysm in NPC patients with prior neck radiation is an uncommon but life-threatening complication. Concomitant carotid stenosis with ischemic stroke and carotid rupture from pseudoaneurysm is rare.


CASE REPORT
A 71-year-old man had a history of NPC treated with radiation therapy 26 years ago. He was admitted to the hospital because of minor ischemic stroke and tarry stool. The carotid duplex sonography disclosed severe stenotic lesion in the proximal right internal carotid artery. A subsequent recurrent stroke on day three associated with nasal cavity bleeding resulted in an endotracheal intubation. Another episodic of massive epistaxis occurred on day 10 caused hypovolemic shock. Pseudoaneurysm of the left internal carotid artery was found by emergent angiography and was immediately obliterated by endovascular treatment with microcoils and glue.


CONCLUSION
Carotid blowout syndrome in NPC patients during acute ischemic stroke warrants further cervical angiographic study. Endovascular treatment provides immediate hemostasis and obliteration of ICA pseudoaneurysm.