Delayed dissection of the internal carotid artery following major facial trauma: a case report

Abstract

Dissection of the internal carotid artery is often caused by trauma to the face or neck. It usually has a delayed onset neurological presentation, a partial middle cerebral artery territory syndrome, 'normal' early CT scan, MRI evidence of middle cerebral artery occlusion, progressive partial or complete neurological recovery, and duplex scan evidence of a reestablished lumen in the internal carotid artery after 10 weeks. A case is reported of a dissection of the right internal carotid artery in a patient with severe facial trauma. The patient presented with a left sided hemiplegia 8 hours after a motor vehicle accident. A cerebral CT scan performed 16 hours after the accident revealed a small wedge shaped area of cerebral infarction within the right temporo-parietal region. An MRI angiogram performed four days after the accident revealed a right carotid artery dissection with an occlusive thrombus of the dissected portion of the right internal carotid artery and right middle cerebral artery and a haemorrhagic infarct of the right parieto-occipital lobe. The patient was anticoagulated and over the next two weeks made a slow recovery, using her left hand effectively and walking unaided. Four months after the accident a duplex scan revealed that the right carotid artery lumen was patent with normal arterial flows. Five months after the accident the patient had returned to work.