Traumatic Occlusion of the Extracranial Internal Carotid Artery

Abstract

Two cases of tapered occlusion of the unilateral internal carotid artery after head and facial injury are reported. The first was a 42-year-old male admitted because of left hemiparesis 3 hours after receiving blows to the face. Computed tomography (CT) scan obtained 10 hours after injury showed an area of slight low density in the right frontotemporal region. Carotid angiography demonstrated tapered occlusion of the right cervical internal carotid artery. A large cerebral infarction had developed in the right hemisphere and the patient died 10 days after the traumatic incident. The second case involved a 45-year-old male hospitalized with aphasia and right hemiparesis about 1 month after incurring a depressed fracture of the left temporal bone. CT revealed two small low-density areas in the left corona radiata, and carotid angiography disclosed tapered occlusion of the left cervical internal carotid artery. The neurological signs gradually improved after anticoagulant therapy. Early diagnosis of traumatic cervical carotid artery occlusion may be difficult in the absence of apparent cervical trauma with focal cerebral symptoms appearing after a lucid interval. No definitive management has been established and the prognosis is poor. It is emphasized that unusual neurological symptoms following head or cervical trauma should provoke suspicion of carotid artery injury, which, on diagnosis, should be promptly treated.