本文描述了以下病例：一名63岁的肺结节病患者，长期使用美地松治疗后出现剧烈鼻衄，并在入院时出现中风的临床表现。入院时的脑部计算机断层扫描（CT）显示蝶窦后壁破坏，左眼视神经投影区有密度增高的区域，被认为是蝶窦的肿瘤或炎症性变化。CT血管造影显示左侧内颈动脉（LICA）从C1段开始完全闭塞。在血栓取出时，患者出现鼻腔剧烈出血。根据分段血管造影，恢复了LICA到蝶窦段的顺行血流；在剧烈出血的背景下，可以看到对比剂从LICA进入蝶窦，进一步到达鼻咽部；在蝶窦的投影中，发现了一个需要区分巨大动脉瘤、动静脉瘘和蝶窦肿瘤的结构。根据临床需要，在岩骨段水平进行了支持性血管栓塞术，停止了出血，但患者因急性出血性贫血而死亡。尸检发现了LICA的真菌性动脉瘤，并导致鼻出血，后来因形成扩展性血栓而暂时停止。这反过来成为中风的原因。

The article describes the following case: a 63-year-old patient with sarcoidosis, who was on long-term therapy with metipred, developed profuse epistaxis, and upon admission to the hospital, clinical manifestation of stroke. Computer tomography (CT) of the brain at admission revealed destruction of the posterior wall of the sphenoid bone and an area of increased density in the projection of the left optic nerve regarded as a neoplasm of the sphenoid sinus or inflammatory changes. CT angiography revealed the occlusion of the left internal carotid artery (LICA) from the C1 segment throughout. At the time of thrombus extraction, the patient developed profuse bleeding from the nasal cavity. According to staged angiography, the antegrade blood flow through the LICA to the sphenoid segment was restored; against the background of profuse bleeding, the flow of contrast from the LICA into the sphenoid sinus and further into the nasopharynx is visualized; in the projection of the sphenoid sinus, a formation was revealed that required differentiation between a giant aneurysm, an arteriovenous fistula, and a neoplasm of the sphenoid sinus. Destructive embolization of the LICA at the level of the petrosal segment was performed for vital indications, the bleeding was stopped, but the patient died due to acute posthemorrhagic anemia. An autopsy revealed a mycotic aneurysm of the LICA, the rupture of the wall of which caused nasal bleeding, which was spontaneously stopped due to the formation of an extended thrombus, which, in turn, became the cause of stroke.