open access

Vol 51, No 5 (2017)
Case reports
Submitted: 2017-02-10
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Traumatic bilateral dissection of cervical internal carotid artery in the wake of a car accident: A case report

N. Taoussi, A.J. Alghamdi, J. Bielewicz, P. Luchowski, K. Rejdak
DOI: 10.1016/j.pjnns.2017.07.002
·
Neurol Neurochir Pol 2017;51(5):432-438.

open access

Vol 51, No 5 (2017)
Case reports
Submitted: 2017-02-10

Abstract

Background

Bilateral carotid artery dissection secondary to severe trauma is rare and can be potentially life -threatening if not diagnosed and treated properly.

Case Presentation

We report a 29-year-old female who was admitted to the emergency department after a car accident. The patient was conscious at the time of admission and presented with an initial Glasgow Coma Scale (GCS) of 15 presenting normal vital signs. The patient developed motor dysphasia with right upper limb paresis a few hours after the admission. Magnetic resonance imaging (MRI) revealed a bilateral cervical internal carotid artery (ICA) occlusion in addition to left frontal lobe infarct in a subacute phase. Medical management was successful and the patient was discharged from the hospital two weeks after the admission.

Discussion

Noninvasive vascular imagining modalities are merging as the gold standard in the early detection of carotid artery dissection (CAD). Typical pathognomonic findings on MRI include double lumen and intimal flap. The management with systemic anticoagulation or antiplatelet therapy is aimed to prevent the development of ischemic stroke. In case of medical therapy being ineffective or in case of complication or any disorders suffered by a patient, endovascular treatment is performed.

Conclusion

With early detection and proper management, traumatic dissection of cervical carotid artery can have a benign outcome. As for the current patient, medical treatment with anticoagulation was sufficient and surgical management was therefore not required. Improvement in the patients’ speech was observed; nevertheless the continuation of speech therapy was indicated.

Abstract

Background

Bilateral carotid artery dissection secondary to severe trauma is rare and can be potentially life -threatening if not diagnosed and treated properly.

Case Presentation

We report a 29-year-old female who was admitted to the emergency department after a car accident. The patient was conscious at the time of admission and presented with an initial Glasgow Coma Scale (GCS) of 15 presenting normal vital signs. The patient developed motor dysphasia with right upper limb paresis a few hours after the admission. Magnetic resonance imaging (MRI) revealed a bilateral cervical internal carotid artery (ICA) occlusion in addition to left frontal lobe infarct in a subacute phase. Medical management was successful and the patient was discharged from the hospital two weeks after the admission.

Discussion

Noninvasive vascular imagining modalities are merging as the gold standard in the early detection of carotid artery dissection (CAD). Typical pathognomonic findings on MRI include double lumen and intimal flap. The management with systemic anticoagulation or antiplatelet therapy is aimed to prevent the development of ischemic stroke. In case of medical therapy being ineffective or in case of complication or any disorders suffered by a patient, endovascular treatment is performed.

Conclusion

With early detection and proper management, traumatic dissection of cervical carotid artery can have a benign outcome. As for the current patient, medical treatment with anticoagulation was sufficient and surgical management was therefore not required. Improvement in the patients’ speech was observed; nevertheless the continuation of speech therapy was indicated.

Get Citation

Keywords

Internal Carotid arteries, Carotid artery dissection, Neck trauma, Ischemic stroke

About this article
Title

Traumatic bilateral dissection of cervical internal carotid artery in the wake of a car accident: A case report

Journal

Neurologia i Neurochirurgia Polska

Issue

Vol 51, No 5 (2017)

Pages

432-438

DOI

10.1016/j.pjnns.2017.07.002

Bibliographic record

Neurol Neurochir Pol 2017;51(5):432-438.

Keywords

Internal Carotid arteries
Carotid artery dissection
Neck trauma
Ischemic stroke

Authors

N. Taoussi
A.J. Alghamdi
J. Bielewicz
P. Luchowski
K. Rejdak

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