Intra-cavernous aneurysm of the internal carotid artery complicating sphenoid sinusitis

Introduction. Mycotic or post-infectious aneurysm of the intra-cavernous portion of the internal carotid artery is uncommon. Case report. We report here the case of a patient who developed progressive left ophthalmoplegia, with left hemi-crania three weeks after a tooth extraction. The patient was febrile. Neuroradiological and microbiological analysis led to the diagnosis of sphenoidal and ethmoidal sinus infection with extension to the left cavernous sinus. An aneurysm of the intra-cavernous portion of the left internal carotid artery was also found. Conclusions. The risk of rupture for this kind of aneurysm is difficult to assess. Treatment always consists in prolonged and adapted antibiotic therapy. For certain patients neurosurgical or endovascular repair is necessary. We followed our patient for four years without surgical intervention. The diameter of the aneurysm has remained stable.