Massive haematemesis complicated with an acute ischaemic stroke due to internal carotid artery pseudoaneurysm

Haematemesis, commonly associated with upper gastrointestinal disorders, can rarely result from cranial vascular anomalies like internal carotid artery aneurysms (ICAAs). ICAA rupture may cause fatal nasopharyngeal epistaxis, with swallowed blood presenting as hematemesis, posing a diagnostic challenge. We report a 75-year-old woman with life-threatening haematemesis, epistaxis, and right hemiplegia. Despite negative findings from otolaryngological and gastrointestinal evaluations, CT angiography identified a left internal carotid pseudoaneurysm. This case emphasizes the importance of considering cranial vascular anomalies in patients with unexplained epistaxis and haematemesis. Endovascular stent embolisation is recommended for managing ICAAs while preserving arterial integrity.