• Gennadiy A Katsevman, John A Braca, Kevin C Welch, and William W Ashley.
• Department of Neurological Surgery, West Virginia University, Morgantown, West Virginia, USA.
• World Neurosurg. 2016 Aug 1; 92: 585.e13-585.e19.

BackgroundEpistaxis is a very common medical condition and can often be controlled with conservative measures. Rarely, uncontrolled and life-threatening epistaxis can occur.Case DescriptionWe present the case of a 58-year-old man who developed delayed, massive epistaxis caused by an extracranial left internal carotid artery pseudoaneurysm caused by an intranasal foreign object without apparent recent trauma. The patient was successfully treated with endovascular stenting of the affected vessel segment.ConclusionsMassive epistaxis is a potentially lethal condition. Although the source uncommonly originates from the internal carotid artery, pseudoaneurysm rupture needs to be considered on the differential diagnosis in selected patients. This case illustrates the need for vigilance for the presence of foreign objects and/or vessel injuries in the setting of acute, massive epistaxis. Additionally, we describe treatment options and review the literature.Copyright © 2016 Elsevier Inc. All rights reserved.

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