Stroke Secondary to Traumatic Carotid Artery Injury - A Case Report

Abstract

Introduction: Lesions of the carotid and vertebral arteries secondary to direct trauma, called blunt cerebrovascular injuries (BCVI) are relatively rare and are markedly different from spontaneous dissections. Ischaemic stroke is a significant complication, with high morbidity and mortality rates. The basis of a diagnosis relies on appropriate, high sensitivity imaging screening.

Case report: We present the case of a 31 years old male patient with polytraumatism secondary to a motor vehicle accident, who was admitted to an orthopaedic clinic for multiple lower extremity fractures. His fractures were treated surgically. He developed in the 3rd day after the admission left sided hemiparesis secondary to ischaemic stroke. The diagnosis of traumatic carotid artery injury (TCAI) was based on duplex ultrasound and angio CT scans. The outcome was favourable despite the severe carotid lesions presenting with occlusion secondary to dissection.

Conclusions: In the majority of BCVI cases there is a variable latent period between the time of injury and the development of stroke. The management of cases is challenging because in the majority of cases there are multiple associated injuries. Although antithrombotics are widely used in the treatment, there is no consensus regarding the type of agent, the optimal dose or treatment duration.

Keywords: blunt cerebrovascular injuries; carotid artery; post-traumatic dissection; stroke; traumatic carotid artery injury.

Fig. 1

Cerebral CT scan, axial sections revealing a right middle cerebral artery infarction

Fig. 2

T2-FLAIR weighted cerebral MRI, axial sections revealing a right middle cerebral artery infarction.

Fig. 3

Ultrasound examination of the right internal carotid artery. a. B-mode ultrasound examination revealing a white line in the vascular lumen (arrow) suggestive of an intimal flap; b. Colour mode ultrasound examination revealing a significant narrowing of the lumen secondary to the hypoechoic mural haematoma (blue line)

Fig. 4

Angio-CT examination of the cervical vessels revealing tapering occlusion, suggestive for ICA dissection.