Isolated internal carotid artery dissection after a motorcycle accident: A case report

Yıl 2024, Cilt: 37 Sayı: 2, 259 - 262, 31.05.2024

Morteza Ashrafi Sayed Mahdi Marashi Foroozan Faress Morteza Taheri Bahman Mohamadi

https://doi.org/10.5472/marumj.1487503

Öz

Extra cranial carotid artery dissection is one of the most important complications associated with blunt head and neck trauma. It
is a major cause of ischemic stroke in young adults. We report a case of internal carotid artery dissection which caused transient
hemiparesis, horizontal gaze to right and anisocoria in a 19-year-old male motorcyclist involved in a collision. Unenhanced brain
computed tomography scan showed well defined infarction in the right frontotemporoparietal area. Digital subtraction angiography
showed complete occlusion of the proximal cervical right internal carotid artery. Moreover, intimal dissection was observed in distal
cervical left internal carotid artery which did not limit blood flow to the brain. A stent was placed at the site of dissection in the left
internal carotid artery. Intravenous heparin was commenced to avoid further thrombosis. He was discharged home 40 days after the
accident with oral anticoagulation. Extra cranial carotid artery dissection is a rare condition which may happen after a non-significant
neck trauma. Accordingly, the diagnosis of a cervical vascular dissection requires strong clinical suspicion

Anahtar Kelimeler

Case report, Carotid artery, Traumatic dissection, Cerebral infarction, Traffic injuries

Kaynakça

• Brand S, Teebken OE, Bolzen P, et al. Traumatic dissection of carotid arteries caused by high energy motorcycle accident [Article in German]. Unfallchirurg 2012;115:930-5. doi:: 10.1007/s00113.011.2078-7
• Molacek J, Baxa J, Houdek K, Ferda J, Treska V. Bilateral posttraumatic carotid dissection as a result of a strangulation injury. Ann Vasc Surg 2010;24:1133.e9-11. doi: 10.1016/j. avsg.2010.02.042.
• Biller J, Sacco RL, Albuquerque FC, Demaerschalk BM, Fayad P, Long PH, et al. Cervical arterial dissections and association with cervical manipulative therapy: a statement for healthcare professionals from the american heart association/american stroke association. Stroke 2014;45:3155-74. I: 10.1161/ STR.000.000.0000000016
• Biffl WL, Ray CE Jr, Moore EE, et al. Treatment-related outcomes from blunt cerebrovascular injuries: importance of routine follow-up arteriography. Ann Surg 2002;235:699-706. doi: 10.1097/00000.658.200205000-00012.
• Baumgartner RW, Arnold M, Baumgartner I, et al. Carotid dissection with and without ischemic events: local symptoms and cerebral artery findings. Neurology 2001;57:827-32. doi: 10.1212/wnl.57.5.827.
• Wachal K, Koczewski P, Gabriel M, Kociemba W. Isolated internal carotid artery dissection in a long-distance runner. Wideochir Inne Tech Maloinwazyjne 2016;11:304-8.
• López-Sánchez M, Ballesteros-Sanz MA, Pérez-Ceballos A, González-Fernández C, López-Espadas F. Traumatic dissection of the internal carotid artery by a safety belt: a report of two cases [Article in Spanish]. Med Intensiva 2009;33:353- 7.
• Wachal K, Koczewski P, Gabriel M, Kociemba W. Isolated internal carotid artery dissection in a long-distance runner. Wideochir Inne Tech Maloinwazyjne 2016;11:304-8. Wachal K, Koczewski P, Gabriel M, Kociemba W. Isolated internal carotid artery dissection in a long-distance runner. Wideochir Inne Tech Maloinwazyjne 2016;11:304-8.
• Benninger DH, Baumgartner RW. Ultrasound diagnosis of cervical artery dissection. Front Neurol Neurosci 2006;21:70-84.
• Galyfos G, Filis K, Sigala F, Sianou A. Traumatic Carotid Artery Dissection: A Different Entity without Specific Guidelines. Vasc Specialist Int 2016;32:1-5.
• Rutman AM, Vranic JE, Mossa-Basha M. Imaging and management of blunt cerebrovascular injury. Radiographics 2018;38:542-63.
• Petetta C, Santovito D, Tattoli L, Melloni N, Bertoni M, Di Vella G. Forensic and clinical issues in a case of motorcycle blunt trauma and bilateral carotid artery dissection. Ann Vasc Surg 2020;64:409.e11-409.e16.
• Tsivgoulis G, Sharma VK, Lao AY, Malkoff MD, Alexandrov AV. Validation of transcranial Doppler with computed tomography angiography in acute cerebral ischemia. Stroke 2007;38:1245-9