Cheng-Lun Hsiao1, Yueh-Hua Tsai2, Shinn-Kuang Lin1. 1. Stroke Center and Departments of Neurology, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Taiwan. 2. Diagnostic Radiology, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Taiwan.
Abstract
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.
PURPOSE: Carotid blowout syndrome due to rupture of internal carotid artery pseudoaneurysm in NPCpatients 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 NPCpatients during acute ischemic stroke warrants further cervical angiographic study. Endovascular treatment provides immediate hemostasis and obliteration of ICA pseudoaneurysm.