Although epistaxis is commonly seen in otorhinolaryngologic practice, it may rarely become a severe and life-threatening problem. Pseudoaneurysm of internal carotid artery (PICA) is an uncommon, but potentially fatal cause of epistaxis. Optimal management demands rapid recognition and treatment to give the best functional outcome. High suspicion and carotid arteriography is essential for diagnosis. In this article, a 28-year-old male case with post-traumatic cavernous PICA localized to sphenoid sinus and presenting with intractable epistaxis was reported. The patient was managed by endovascular covered stent application successfully. In differential diagnosis of patients with intractable epistaxis and isolated sphenoid sinus lesions, PICA should be considered. Early treatment with covered stent of aneurysm can be a life saving therapeutic approach. © 2004 Elsevier Ireland Ltd. All rights reserved.