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.