Intracranial Pseudoaneurysm Misdiagnosed as Recurrent Epistaxis: A Case Report

성충만,김도형,김홍찬,양형채 대한이비인후과학회 부산,울산,경남 지부회 2023 임상이비인후과 Vol.34 No.4

Epistaxis is a relatively common otolaryngological emergency, however, repeated episodes of epistaxis should pay attention to the potential for alternative causes. We report a case of a patient who experienced recurrent epistaxis due to an intracranial pseudoaneurysm. At the initial visit, the patient had no history of trauma or surgery and displayed no neurological symptoms other than repeated epistaxis. Suspecting common causes for epistaxis, we performed a nasal exploration but could not identify the bleeding site. However, after the recurrence of epistaxis, endoscopic exploration revealed an aneurysm within the sinus. Emergency angiography and coil embolization were then performed to treat the condition, but stent-assisted coil embolization was subsequently executed due to symptom recurrence. An intracranial pseudoaneurysm in the sphenoid sinus can manifest solely with epistaxis, and rapid diagnosis can be challenging without a suggestive history. Although epistaxis is relatively common, a differential diagnosis is required if symptoms persist.

Relationship between Meteorological Factors and Emergency Department Visits for Epistaxis in Korea

김종준,최재원,임현우,송용진,여남경 대한이비인후과학회 2014 대한이비인후과학회지 두경부외과학 Vol.57 No.4

Background and Objectives Epistaxis may be related to changes in weather, but this relationship has not been well-defined. We investigated the effects of climate fluctuations (temperature, humidity, and barometric pressure) on the number of emergency department (ED) visits for epistaxis. Subjects and Method In total, our study population included 1910 patients who visited the ED of a large, urban hospital during a 5-year period for epistaxis. Patients with clear etiology for epistaxis (trauma, iatrogenic, coagulopathy, and/or hypertension) were excluded, leaving 912 patients for subsequent analysis. Daily climate data was collected through the Korea Meteorological Administration. Correlation between epistaxis ED visits and weather variables were investigated using Poisson distribution and multiple regression analysis. The effect of climate factor was evaluated on the day and up to 3 days prior to ED presentation. Additionally, analyses were conducted separately for children (<15 years-old), adults (15-64 years-old), and elderly patients (≥65 years-old). Results Changes in the lowest temperature 2 days prior to ED presentation significantly increased the number of ED visits for epistaxis (β=-0.043, p=0.033). No associations were found between the number of ED visits and changes in humidity or atmospheric pressure. However, in children, interday changes in the highest atmospheric pressure between 2 and 3 days prior to ED presentation were both significantly associated with increased number of epistaxis ED visits. Conclusion Cold temperatures 2 days prior to ED presentation were related to the increased incidence of epistaxis. Fluctuations in barometric pressure appear to influence the number of pediatric ED visits for epistaxis. Korean J Otorhinolaryngol-Head Neck Surg 2014;57(4):233-8

유전성 출혈성 모세혈관 확장증으로 진단받지 않은 반복적인 비출혈 환자에서의비중격 식피술 증례

이영주,장용주 대한이비인후과학회 2023 대한이비인후과학회지 두경부외과학 Vol.66 No.12

Epistaxis is a common disease, most of which is naturally improved without treatment. How-ever, some patients experience recurrent epistaxis despite having received various treatments. In such cases, the control of epistaxis may require a more invasive technique, such as emboli-zation or surgical ligation of the main feeding arteries of the nasal cavity. However, the nasalseptum receives blood supply from various branches of blood vessels, so these vascular con-trols can be inappropriate. In this case report, we applied septodermoplasty - a surgical tech-nique mostly aimed for the treatment of intractable epistaxis from hereditary hemorrhagic tel-angiectasia (HHT) - to treat patients suffering recurrent epistaxis from the nasal septum. Although the two patients we treated were non-HHT, our application of this surgical tech-nique turned out to be successful. Here, we suggest expanding the indication of septodermo-plasty to non-HHT patients presenting with recurrent and difficult-to-treat epistaxis.

후방 비출혈의 위험 인자 및 접형구개동맥 결찰술 실패요인 분석

이호중,조현진,주연희,전시영,김상욱 대한이비인후과학회 2016 대한이비인후과학회지 두경부외과학 Vol.59 No.5

Background and Objectives Most cases of epistaxis can be controlled by conservative management such electrocautery or nasal packing. However, for some cases of the posterior epistaxis, invasive procedures like endoscopic sphenopalatine artery ligation (SPAL) or arterial embolization are needed. In this study, risk factors present in patients who were hospitalized due to posterior epistaxis and postoperative complications and causes of recurrence after SPAL were analyzed. Subjects and Method A retrospective chart review of 75 patients who were admitted to Gyeongsang National University Hospital for the treatment of posterior epistaxis between 2009 and 2014 was performed. Demographic factors, seasonal variation, comorbid diseases, and laboratory results were analyzed. Furthermore, 35 patients who have undergone SPAL were surveyed by telephone regarding postoperative complications, and preoperative computerized tomography (CT) images were reviewed to figure out the causes of the recurrence after SPAL. Results Among 75 patients, 53 (70.7%) were males. Male preponderance (80%) was more definite among those who have undergone SPAL (p=0.04). Age over 40 as well as the winter season and the underlying disease such as hypertension were also critical risk factors for posterior epistaxis. Four out of 35 patients who had undergone SPAL showed recurrence. The bleeding was detected in the branches of sphenopalatine artery in three out of the four patients who experienced recurrent bleeding following SPAL, which were controlled by revision surgery or arterial embolization. Conclusion Posterior epistaxis occurred frequently in men over 40 years of age and in winter. A careful preoperative review of CT images and meticulous dissection during SPAL might be helpful for preventing recurrence after SPAL. Korean J Otorhinolaryngol-Head Neck Surg 2016;59(5):366-72

고령 환자에서 발생하는 재발성 비출혈의 특성과 위험요인에 대한 연구

김소정,이소정,고유진,박솔,배정호 대한이비인후과학회 2021 대한이비인후과학회지 두경부외과학 Vol.64 No.8

Background and Objectives Recurrent epistaxis requiring emergency department (ED)visits results in increased morbidity in the elderly and associated with high health care costs. This study is to analyze the frequency and characteristics of epistaxis patients in the elderlyand to find out the risk factors and effective treatment for recurrent epistaxis. Subjects and Method We studied retrospectively the clinical cases of 977 emergency patientsand 155 patients, aged over 65, for the treatment of epistaxis during the last 10 yearsfrom January 2008 to January 2018. The group A, comprised of 95 patients (68.29%), wastreated with an initial treatment. The group B, which comprised of 60 patients (38.71%), visitedfor re-bleeding following an initial treatment. Results Patients made 2 to 10 ED visits due to re-bleeding and 32 of the 60 patients (53.5%)visited twice. The electrocauterization was the most common (61.7%) for treatment methodduring rebleeding, followed by posterior packing (18.3%). The factors that increases the riskof recurrent epistaxis are anticoagulants, posterior epistaxis, anterior packing, inefficient EDpacking. There was no correlation between comorbidities and rebleeding. Conclusion Accurate medical history taking of anticoagulants may enable personnel to providemore effective management of these patients. The most important factors in the failure ofprimary care were not being able to find the precise area of bleeding and ineffective packingduring the initial treatment. Therefore, it is important that we must carefully check the areasusing the endoscope to decrease the failure of initial treatment of epistaxis.

후방 비출혈 환자에서 비내시경하 전기소작술의 치료효과

김재영,이민우,김진국,한창준,남태욱,임채형 건국대학교 의과학연구소 2001 건국의과학학술지 Vol.11 No.-

Background and Objectives : Epistaxis is a common disease from which approximately 10% of the normal population have suffered in their life. Most bleeding sites of epistaxis are located anteriorly and easily controlled. However posterior epistaxis presents significantly great problems. A number of different treatment modalities are used to control the posterior epistaxis. Although not widely practiced, the nasal endoscopic electrocautery has also been effective. The purpose of this article is to report on the efficacy of nasal endoscopic electrocautery as an alternative and adjuvant to the standard approach for control of posterior epistaxis. Materials and Methods: We conducted retrospective chart review about 19 cases of posterior epistaxis treated from January 1998 to December 1999. Group I patients were managed by nasal packing only and group II patients were managed by nasal packing and endoscopic electrocautery. Results: Hospital days were 5.9 days in the group I and 3.6 days in the group II. The duration of nasal packing was 4.1 days in the group I and 1.8 days in the group II. The results were significant statistically Conclusion: Nasal endoscopic electrocautery was an effective treatment modality for control of posterior epistaxis.

소아 비출혈의 한약 치료에 대한 임상 연구 동향 - 2000년대 이후 발표된 중국 RCT 연구를 중심으로 -

박용석,신혜진,이지홍,장규태 대한한방소아과학회 2020 대한한방소아과학회지 Vol.34 No.1

목적: 이 연구의 목적은 중국에서 진행되고 있는 소아 비출혈의 한약치료의 효과에 대한 최근의 임상연구를 분석하여, 향후 국내에서 소아 비출혈에 대해 새로운 치료법의 개발 및 후행연구를 할 수 있는 기틀을 마련하기 위함이다. 방법: 중국 전자 데이터베이스 검색사이트인 중국학술정보원 (China National Knowledge Infrastructure, CNKI)을 이용하였으며, 검색어는 ‘鼻出血’, ‘鼻衄’, ‘衄血’, ‘中药’, ‘中医药’, ‘本草’, ‘汤’, ‘丸’, ‘散’, ‘方’,‘颗粒’, ‘胶囊’, ‘自拟’, ‘外用’, ‘膏’를 사용하여 2000년 1월에서 2019년 11월까지의 문헌을 검색하였다. 그 후 각 문헌에 나온 치료방법과 결과에 대해 검토하였다. 결과: 1141개의 연구 중, 12개의 RCT 연구가 선정되어 분석되었다. 대부분의 연구에서, 소아 비출혈에 대한 한약치료의 효과는 유의하게 높았으며, 내복약 중에 가장 많이 사용된 본초는 Rehmanniae Radix (生地黃), Scutellariae Radix (黄芩), Imperatae Rhizoma (白茅根) 이었다. 외용약으로 가장 많이 사용된 본초는 Notoginseng Radix (三七), Bletilla striata (白芨), Crinis Carbonisatus (血餘炭)이었다. 결론: 한약치료는 소아 비출혈을 치료하는데 도움이 될 수 있다는 결론을 얻었으며, 이를 뒷받침하기 위한 후행연구가 필요하다. 치료 경과를 정확히 파악할 수 있는 통일된 평가지표도 필요할 것으로 생각된다. Objectives: The purpose of this study is to investigate recent clinical studies on the effect of herbal medicine for pediatric epistaxis in China, and to seek better methods to treat and study for pediatric epistaxis in Republic of Korea. Methods: We searched the clinical studies from the China Academic Journal (CAJ) in China National Knowledge Infrastructure (CNKI) by key words 鼻出血’, ‘鼻衄’, ‘衄血’, ‘中药’, ‘中医药’, ‘本草’, ‘汤’, ‘丸’, ‘散’, ‘方’,‘颗粒’, ‘胶囊’, ‘自拟’, ‘外用’, ‘膏 from January 2000 to November 2019. We analyzed the literature in regards to the treatment methods and results. Results: Among the 1141 searched studies, 12 randomized controlled trials were selected and analyzed. In most of the studies, the effectiveness of herbal medicine on pediatric epistaxis was significantly high. The most commonly used herbs for oral administration were Rehmanniae Radix (生地黃), Scutellariae Radix (黄芩), Imperatae Rhizoma (白茅根). The most commonly used herbs for external applications were Notoginseng Radix (三七), Bletilla striata (白芨), Crinis Carbonisatus (血餘炭). Conclusions: Herbal medicine treatment can help improve pediatric epistaxis. Additional studies need to be performed to solidify these findings. In addition to that, unified criteria for treatment of pediatric epistaxis should be established in Republic of Korea.

Comparison of Local Sclerotherapy With Lauromacrogol Versus Nasal Packing in the Treatment of Anterior Epistaxis

Paolo Farneti,Ernesto Pasquini,Vittorio Sciarretta,Giovanni Macrì2,Giulia Gramellini,Antonio Pirodda 대한이비인후과학회 2016 Clinical and Experimental Otorhinolaryngology Vol.9 No.2

Objectives. Epistaxis is one of the most common otorhinolaryngologic emergencies representing more than 12% of conditions managed at the Ear, Nose and Throat (ENT) Emergency Consulting Room of our Otorhinolaryngologic Unit each year. The elevated frequency of this pathology makes it necessary to adopt the most effective and least expensive therapeutic strategy available. The aim of this study was to compare the efficacy, costs and morbidity of nasal packing (NP), which is the mainstay of treatment for anterior epistaxis in our ENT Emergency Consulting Room versus submucosal infiltrations of lauromacrogol (LA). Methods. A retrospective study was designed from August 2012 to April 2013 involving 53 patients suffering from anterior epistaxis. Anterior NP was used in 27 patients versus 26 patients undergoing 27 procedures performed with submucosal infiltrations of LA (or polidocanol). Outcomes for each treatment were evaluated. Patients in group 1 were treated with LA 400 injection next to the bleeding point: 0.5- to 1-mL single or multiple infiltrations with a 27-gauge needle. The whitening of the nasal mucosa around the bleeding point during infiltration was considered a marker of correct procedure in order to achieve the best results. Bilateral treatment was also performed at the same time. Patients in group 2 were treated with standard NP. Results. Bleeding recurrence was higher in the NP group even if it was not statistically significant (P=0.2935). However, the LA infiltrations were better tolerated with lower morbidity and costs as compared to NP. No complications were observed in either group. Conclusion. LA infiltrations were shown to be a viable alternative in anterior epistaxis treatment. They are safe, easy to use with good efficacy and have a low cost.

육혈(?血) 환자 치험 2례 보고

지선영,이상곤,황순이,Jee, Seon-Young,Lee, Sang-Kon,Hwang, Sun-Yi 대한한방안이비인후피부과학회 2005 한방안이비인후피부과학회지 Vol.18 No.2

Epistaxis is the condition which the blood comes out with the nose. It has been known that nasal bleeding happens with many reasons. In most cases, epistaxis is a slight illness, but sometimes, it leads to death because of longstanding or copious bleeding. First of all, to stop a hemorrhage is most important treatment for epistaxis, but the curative effect of oriental medical treatment for epistaxis does not become known well. We treated a patient suffered from epistasis with acupuncture, herb medication. After treatment we observed the improvement. Based on this study, it is considered that oriental medical treatment can be applied to the management of epistaxis.

재발한 비출혈의 임상양상 분석

임상균,주은정,강기석,위성준,강정한,박정미 대한이비인후과학회 2005 대한이비인후과학회지 두경부외과학 Vol.48 No.9

Background and Objectives:Epistaxis is a frequently seen disease in the field of otorhinolaryngology. However, many patients have to revisit the hospital because of the failure of the initial treatment, in which cases, the inconvenience is greater due to more severe bleeding. We studied epistaxis patients who visited our service during the last 10 years to analyze the causes of visits and the possible countermeasures. Subjects and Method:We studied retrospectively the clinical cases of 616 emmergency patients and 65 patients admitted for the treatment of epistaxis during the last 10 years, from August 1995 to July 2004. The group I, 505 patients (74.2%), improved with only one treatment. The group II, 176 patients (25.8%), showed refractory epistaxis following the initial treatment. Results:In the group I, Kisselbach’s area (68.1%) was the most common site to be treated, followed by Woodruff’s area (13.5%), anterior end of inferior turbinate (8.3%), and superior portion of septum (2.0%). In the group II, the most frequent area to be treated was Woodruff’s area (46.0%), followed by Kisselbach’s area (31.8%), superior portion of septum (4.6%), anterior end of inferior turbinate (4.0%). Conclusion:The most important factor in the failure of primary care was because the precise area of bleeding was not found at the time of initial treatment. Therefore, it is important that we must check the areas by endoscope carefully to decrease the failure of initial treatment of epistaxis.