Traumatic internal carotid artery dissection

Yang, Shun Tai; Huang, Yin; Chuang, Chi‐Cheng; Hsu, Peng Wei

doi:10.1016/j.jocn.2005.02.016

Cited by 41 publications

(38 citation statements)

References 18 publications

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“…Grade V ICAD requires urgent surgical ligation and hemorrhage control. [5] Our patient had a Grade IV ICAD, as diagnosed by MR angiography. The delay in diagnosis at the outlying hospital may have led to the development of permanent neurologic deficits.…”

Section: Discussionmentioning

confidence: 64%

“…The basic pathophysiological mechanism is stretching of the artery through rotation-hyperextension or distractionflexion. [5] While only 10% of cases have an immediate onset of symptoms, in most patients, clinical signs of the dissection occur within the first 24 hours following the traumatic event. No symptoms occur within the first 24 hours after trauma in 35% of cases.…”

Section: Discussionmentioning

confidence: 99%

“…However, 70% of Grade II dissections rapidly progress to pseudoaneurysm formation and occlusion, and thus require aggressive surgical treatment. [5] With the latest improvements in endovascular stenting, successful results have been obtained in Grade I and Grade II ICADs. [10] Grade IV dissections are usually complicated by cerebral embolism and stroke.…”

Section: Discussionmentioning

confidence: 99%

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Cerebral infarction caused by traumatic carotid artery dissection

Bayır¹,

Söylemez²,

Demirci³

2012

Ulus Travma Acil Cerrahi Derg

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Travmatik karotid arter diseksiyonu eğer erken tanı konulup tedavi edilmezse kalıcı nörolojik defisit ve %40'lara varan ölüm oranı yaratabilen ciddi bir sorundur. Bu yazıda, travmatik karotid arter diseksiyonu tanısı geç dönemde konan 21 yaşında kadın hasta sunuldu. Kabulde çekilen beyin bilgisayarlı tomografisinde (BT) iskemik enfarkt bulguları yok iken, bilinci açıldıktan sonra yedinci gün sol hemiplejisi fark edildiğinde çekilen ikinci beyin BT'sinde enfarktüs bulguları saptandı. Hasta acil servise kabul edildi. Kesin tanı, arteriyel Doppler ultrasonografi, serebral manyetik rezonans görüntüleme (MRG), difüzyon MRG ve MR anjiyografi ile konuldu. Hastada kalıcı nörolojik hasar geliştiği ve anjiyografi bulgularına göre evre IV olduğu için invaziv tedavi düşünülmedi. Hasta fizyoterapi tavsiye edilerek bir hafta içinde taburcu edildi. Tanısal yöntemlerde-ki gelişmelere rağmen travmatik karotid arter diseksiyonunun tanısı bu olguda olduğu gibi halen atlanmakta veya gecikmektedir. Erken tanı kalıcı nörolojik hasarı önleyebi-lir ya da hafifletebilir. Bununla birlikte erken tanı için en önemli faktörler uygun radyolojik incelemeyi yönlendire-cek anamnez, ayrıntılı fiziksel inceleme ve yüksek klinik şüphedir.Anahtar Sözcükler: Doppler ultrasonografi; internal karotid arter; manyetik rezonans anjiyografi; travmatik diseksiyon.Traumatic carotid artery dissection, if not diagnosed and treated early, is a serious problem with permanent neurological deficit and a high mortality rate of up to 40%. We present a case with delayed diagnosis of traumatic carotid artery dissection in a 21-year-old female. While there were no ischemic infarct findings on the admission cerebral computerized tomography (CT), such findings were observed on two cerebral CTs taken because of the left hemiplegia noticed seven days later when the patient regained consciousness. The patient was referred to our emergency service, and definitive diagnosis was achieved with arterial Doppler ultrasonography, cerebral magnetic resonance imaging (MRI), diffusion MRI, and MR angiography. We did not consider invasive treatment since the neurological damage was permanent and dissection grade was IV according to angiography findings. The case was discharged within a week and physiotherapy was advised. Despite the advances in diagnostic methods, diagnosis of traumatic carotid artery dissection is still missed or delayed, as in the case presented here. Early diagnosis can ameliorate permanent neurological damage or even prevent it. However, the vital factors for early diagnosis are the obtained anamnesis leading to appropriate radiological examinations, detailed physical examination and high clinical suspicion.

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Section: Discussionmentioning

confidence: 64%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Cerebral infarction caused by traumatic carotid artery dissection

Bayır¹,

Söylemez²,

Demirci³

2012

Ulus Travma Acil Cerrahi Derg

View full text Add to dashboard Cite

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“…Only 10% of patients display immediate symptoms, whereas 35% develop symptoms only 24 hours or more after injury. 8) Delayed neurologic symptoms are related to either progressive hemodynamic impairment or thromboembolism. Blunt cervical trauma associated with carotid artery dissection is relatively uncommon, affecting far less than 1% of patients.…”

Section: Introductionmentioning

confidence: 99%

“…2,5) The onset and severity of a neurologic deficit may depend on multiple factors, so the symptoms may appear immediately after the trauma but more frequently emerge after a delay ranging from hours to months. 6,8) We treated a patient with traumatic carotid artery dissection detected by screening imaging after remaining asymptomatic for 3 months after blunt trauma, who was treated successfully with balloon angioplasty and stent placement.…”

Section: Introductionmentioning

confidence: 99%

Asymptomatic Carotid Artery Dissection Caused by Blunt Trauma -Case Report-

Fuse

Ichihasi

Matuo

2008

Neurol. Med. Chir.(Tokyo)

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A 42-year-old man presented with asymptomatic traumatic carotid artery dissection 3 months after sustaining blunt injury with tracheal laceration. Magnetic resonance imaging performed as a screening procedure for asymptomatic carotid artery injury unexpectedly showed dissection of the carotid artery. Angiography confirmed carotid artery dissection with narrowing of the true lumen. Balloon angioplasty and stent placement were carried out to dilate the true lumen and isolate the false lumen from blood flow. Intravascular ultrasonographic virtual histology defined the precise anatomic structure of the lesion and identified the internal flap as fibrotic. Careful clinical assessment of patients with blunt cervical trauma may permit diagnosis of carotid artery dissection and intervention prior to the development of cerebral ischemic symptoms.

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Traumatic internal carotid artery dissection

Cited by 41 publications

References 18 publications

Cerebral infarction caused by traumatic carotid artery dissection

Cerebral infarction caused by traumatic carotid artery dissection

Asymptomatic Carotid Artery Dissection Caused by Blunt Trauma -Case Report-

Traumatic dissection of the internal carotid artery: simultaneous infarct of optic nerve and brain

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