A case of internal carotid artery aneurysm diagnosed on basis of massive nosebleed

The authors report a rare case of a nontraumatic giant internal carotid aneurysm which ruptured into the nasal cavity, causing massive rhinorrhagia in a 64-year-old Japanese woman. CT images of the head revealed an aneurysm having a diameter of about 5 cm with a neighboring area of erosion of the anterior base of the skull, and a swelling extending to inside the sphenoidal sinuses. Cerebal angiography resulted in a diagnosis of a giant aneurysm of the left internal carotid artery. Coil embolization and other surgical treatments were recommended, but the patient's family refused to consent and requested only conservative therapy. The natural course of the patient was thus followed, and the patient died after repeated episodes of aneurysm rupture and massive nosebleeds. It was concluded that curative therapy should be administered as soon possible upon diagnosis of this disease.