蝶形骨洞由来の致命的鼻出血の2例
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We report herein on two patients with severe epistaxis from the sphenoid sinus resulting in an unfortunate clinical course. A 67-year-old man presenting with severe epistaxis and headache was taken by an ambulance to our hospital. Epistaxis-impaired hemostasis from the sphenoid sinus was observed. The blood examination showed a high inflammatory reaction. Blepharoptosis, dysarthria, and disorientation occurred afterwards. Head magnetic resonance imaging (MRI) demonstrated a left internal carotid artery pseudoaneurysm projecting into the left sphenoid sinus. Endovascular coil embolization of the internal carotid artery to avoid serious hemorrhage was urgently performed after obtaining sufficient informed consent. Although hemostasis was maintained, extensive cerebral infarction occurred after the embolization. Finally the patient died from aspiration pneumonia 5 months after embolization.A 71-year-old man with epistaxis was transported by an ambulance to our hospital. He had a history of surgery and radiation therapy for chordoma. Pulsatile bleeding was observed from the remaining portion of the tumor in the posterior part of sphenoid sinus. He died of serious epistaxis with impaired consciousness after resuscitation attempt following cardiopulmonary arrest.In case of epistaxis from the sphenoid sinus, we should suspect that the internal carotid artery may be involved in the bleeding. A detailed medical history should be obtained, especially any neurosurgical interventions and/or radiation therapy for head and neck tumors. We should check the other symptoms such as cranial nerve symptoms. A blood examination also provides important information. Imaging, especially computed tomography (CT) and MRI, should be performed to check for any lesions surrounding the sphenoid sinus.
- 耳鼻咽喉科臨床学会の論文
耳鼻咽喉科臨床学会 | 論文
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