Traumatic thrombosis of the internal carotid artery following a non-penetrating injury and leading to infarction of the brain

Twelve cases of fatal cerebral infarction due to arterial occlusion in the absence of atheromatous stenosis or embolism.

“…Occlusion of a carotid artery, as in case 1, is a known complication of percutaneous carotid angiography (Abbott, Gay, and Goodall, 1952;Baker, 1960;Lindner, Hardy, Thomas, and Gurdjian, 1962) but is in our experience a very rare occurrence. Traumatic occlusion of the internal carotid artery (case 2) is also well documented (Clarke, Dickson, and Smith, 1955;Murray, 1957;Gurdjian, Hardy, Lindner, and Thomas, 1963;Houck, Jackson, Odom, and Young, 1964;Toakley and McCaffrey, 1965) but of particular interest in the present case was the finding on histological examination of a haematoma between the medial and adventitial coats of the artery. Case 3 suffered from systemic lupus erythematosus, another known cause of arterial thrombosis (Dubois, Commons, Starr, Stein, and Morrison, 1952;Murphy, 1954).…”

Non-penetrating trauma to the carotid artery with secondary thrombosis and embolism: Treatment by Thrombolysin

“…Indeed, the carotid has been injured by manipulation by physicians, as in testing for carotid sinus hypersensitivity (Calverley andMillikan 1961, Nelson andMahru 1963) or during surgery (Calverley andMillikan 1961, Linell andTom 1959). In missile wounds without direct injury, forces transmitted against the vessel wall have also resulted in thrombosis (Caldwell and Hadden 1948, Clarke et al 1955, Frantzen et al 1961, Gurdjian et al 1963, Linell and Tom 1959, Little et al 1969, Murray 1957, Northcroft and Morgan 1944, Raney 1948, Zilka 1970. Blunt trauma can also be delivered to the carotid artery in intraoral injuries since the artery lies close to the surface of the tonsillar fossa (Bickerstaff 1964, Braudo 1956, Caldwell 1936, Fairburn 1957, Miller and Ayers 1967, Pitner 1966, Scott et al 1960, Shillito 1964.…”

“…The carotid is closely related to the lateral masses of C-1 and C-2 and so may be easily compressed against them by direct injuries or stretched across them in extension and rotation (Boldrey et aI. 1956, Clarke et al 1955, Fleming and Petrie 1968, Little et al 1969, New and Momose 1969). An abnormal styloid process could also contribute to the mechanism of injury (Eagle 1949).…”

Traumatic Thrombosis of the Internal Carotid Artery

“…Not surprisingly, of these six patients with more partial lesions, five were survivors so that clinical and post-mortem findings cannot be compared. In the one exception (Clarke, Dickson, and Smith, 1955), where the arm was affected almost 24 hours before the leg, the thrombus was found at necropsy to extend to the origin of the middle and anterior cerebral arteries. Sedzimir (1955) describes an interesting case where thrombotic obstruction of the internal carotid artery, originating from the region where it passes upwards from the cavernous sinus, and associated with rhinorrhoea and a fracture of the cribriform plate, caused paresis of the right arm several hours before coma occurred and some days before the leg was paralysed.…”