Posttraumatic Pseudoaneurysm of Extracranial Internal Carotid Artery Presenting as Massive Oropharyngeal Bleed with Shock and Hemiparesis in a 12-year-old Boy: A Case Report

Aneurysm in the extracranial segment of the internal carotid artery is extremely rare in children. Traumatic aneurysms of the internal carotid artery are generally "false aneurysms" (pseudoaneurysms) with at least part of the aneurysm wall composed only of the adventitial layer, or even just by the hematoma. There are few reports in the world medical literature about its etiology, presenting features, and catastrophic consequences. The natural history of the disease has not been well-defined yet. However, the potential risk of embolism originating from the aneurysm or even its rupture indicates a need for early diagnosis and intervention. We present a 12-year-old previously healthy child with recurrent oropharyngeal hemorrhage leading to massive hematemesis and hypovolemic shock due to right-sided internal carotid artery pseudoaneurysm with hemorrhage and right middle cerebral artery territory infarct. The child required urgent endovascular stenting with decompressive craniectomy for life-threatening intracranial bleeding with herniation with near-complete recovery.