Images in vascular medicine

Abstract

Internal carotid artery (ICA) dissection is a rare complication of major trauma,1,2 typically presenting soon after injury with symptoms of major stroke.3 ICA dissections also occur following minor trauma, and may present with more trivial symptoms, typically headache associated with focal neurological signs. The classic triad of Horner’s syndrome and pain, followed by cerebral or retinal ischaemic symptoms, is present in only about 20% of patients with ICA dissection.4 In cases of major trauma, disruption of the ICA is often present on initial trauma CT scanning, or becomes apparent early following the development of symptoms suggestive of cerebral ischaemia or infarction reflecting disruption of the ICA. It appears to be much less common for ICA dissection to present with focal neurological signs late following major trauma, as in the case outlined below. A previously well 36-year-old motorcyclist was thrown from his bike into a passing car, sustaining multiple leftsided long bone and pelvic fractures which required extensive ortho-plastic reconstruction and a prolonged stay on the intensive care unit. Two left neck lacerations were explored surgically at initial presentation; the carotid sheath was intact. As the patient recovered he reported some visual loss in the left eye. Clinical examination revealed a Panel A