Blunt trauma to the head and neck can result in an acquired aneurysm or arteriovenous fistula. Rupture of the aneurysm can cause epistaxis, which may be massive.
Clinical features:
(1) history of facial trauma
(2) onset of epistaxis some time later
(3) evidence of an aneurysm or vascular malformation
A patient with risk factors for cerebrovascular injury should have angiography performed to detect vascular sequelae of head trauma. An aneurysm that is identified should be treated (resection, obliteration, stent, etc) to avoid delayed rupture.
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