Delayed Dissection of the Internal Carotid Artery Following Major Facial Trauma: A Case Report
ABSTRACT
Dissection of the internal carotid artery is often caused by trauma to the face or neck. It usually has a delayed onset neurological presentation, a partial middle cerebral artery territory syndrome, 'normal' early CT scan, MRI evidence of middle cerebral artery occlusion, progressive partial or complete neurological recovery, and duplex scan evidence of a reestablished lumen in the internal carotid artery after 10 weeks.
A case is reported of a dissection of the right internal carotid artery in a patient with severe facial trauma. The patient presented with a left sided hemiplegia 8 hours after a motor vehicle accident. A cerebral CT scan performed 16 hours after the accident revealed a small wedge shaped area of cerebral infarction within the right temporo-parietal region. An MRI angiogram performed four days after the accident revealed a right carotid artery dissection with an occlusive thrombus of the dissected portion of the right internal carotid artery and right middle cerebral artery and a haemorrhagic infarct of the right parieto-occipital lobe.
The patient was anticoagulated and over the next two weeks made a slow recovery, using her left hand effectively and walking unaided. Four months after the accident a duplex scan revealed that the right carotid artery lumen was patent with normal arterial flows. Five months after the accident the patient had returned to work. (Critical Care and Resuscitation 1999; 1: 285-287)
Key words:
Carotid artery dissection, internal carotid artery, facial trauma, cerebral infarction
