Posttraumatic Ophthalmic Artery Pseudoaneurysm Presenting Epistaxis: Case Report and Review of the Literature

Background: Traumatic brain aneurysms represent approximately 1% of brain aneurysms. Most frequently, these aneurysms are associated with skull base fractures. Traumatic pseudoaneurysms (PsA) of the ophthalmic artery (OphA) are extremely rare after severe head injury. We report an unusual example presenting as persistent posttraumatic epistaxis, with review of the literature.

Case Report: The patient was a 48-year-old woman presented in a comatose state to the emergency room after a 7-meter fall. Her right eye had proptosis and an unreactive 6-mm dilated pupil. Brain CT scan revealed contusions of the frontotemporal lobes and fracture of the anterior cranial base and tri-wall fracture of the orbits. She had persistent epistaxis. Cerebral digital subtraction angiography (DSA) showed a 6 × 3 mm PsA arising from the intraorbital segment of the right OphA. Attempted endovascular embolization resulted in unsuccessful access into the PsA but unexpected therapeutic occlusion of the proximal OphA and in turn the PsA. Cerebral DSA 10 days later confirmed persistent occlusion of the aneurysm. Extensive review of the medical literature including Medline, PubMed, and Google Scholar, as well as major neurosurgery and trauma journals, yielded only nine previously reported posttraumatic PsAs of the OphA.

Conclusion: Posttraumatic pseudoaneurysms of the ophthalmic artery are very rare; however, it should be suspected in the setting of anterior skull base or orbital wall fractures and persistent or delayed epistaxis.