Bilateral Blunt Traumatic Dissections of the Extracranial Internal Carotid Artery: A Case Report and Literature Review

Abstract

Bilateral traumatic dissections of the cervical internal carotid artery (ICA) are rare complications of polytrauma. A thorough literature review was performed, and data from selected studies were analyzed to assess the trends in clinical presentation, modes of trauma, management protocols, and clinical outcomes. The reported outcomes were categorized and graded into optimal, intermediate, and poor outcomes. We describe a rare case of bilateral dissection of ICA in a 31-year-old woman who was involved in a motor vehicle accident. She had a Glasgow Coma Scale score of 9 and right-sided hemiparesis. Radiological findings revealed left upper ICA dissection, arterial intramural thrombus, and stenosis of the upper segment of the right ICA. She improved on conservative management and had a good clinical outcome at a three-month follow-up. Emergency physicians must be knowledgeable about such cases, as more than half of these trauma victims are initially asymptomatic on initial presentation. Specific diagnostic and therapeutic modalities should be implemented based on low threshold clinical suspicion to avoid missing these potentially disabling injuries and reduce morbidity and mortality. Computed tomographic angiography is recommended in cases with atypical clinical presentations, unexplained neurological deficits, or delayed-onset clinical deterioration. While antiplatelet and anticoagulant therapies are the mainstays of conservative management, endovascular and surgical management are only used in severe cases when medical treatment has failed, the artery has been completely transected, or there is active bleeding. Generally, good outcomes were reported in about two-thirds of those patients.

Keywords: cervical; dissections; internal carotid artery; traumatic brain injury; vascular dissection.

Figure 1. (A, B) Initial post-traumatic axial computed tomography of the brain showing multiple bilateral hemispheric hypodense area multiple strokes (red circle).

Figure 2. Initial coronal computed tomography angiogram of the neck showing left upper cervical ICA dissection (red arrow) and evidence of arterial intramural thrombus, in addition to stenosis of the upper segment of right ICA (blue arrow)

R: right side; L: left side; ICA: internal carotid artery

Figure 3. A follow-up coronal computed tomography angiogram of the neck showing normal left internal carotid artery (red arrow) and mild residual right internal carotid stenosis (blue arrow).

R: right; L: left