Summary Traumatic injuries of the internal carotid artery can result in severe neurologic morbidity and mortality if left untreated. Its unprotected course in the neck and close apposition to cranial base structures makes it vulnerable to various injuries sustained during head and cervical trauma. Penetrating and blunt traumatic injuries include transections, intimal tears, thromboses, dissections, pseudoaneurysms, and carotid-cavernous fistulas. Both penetrating and blunt injuries to the extracranial and intracranial portions of the internal carotid artery offer different diagnostic and therapeutic challenges. Diagnosis of these lesions requires a knowledge of the potential complications and a high index of suspicion in suspected cases. Although the natural history of traumatic internal carotid artery lesions is often difficult to determine, astute observations and therapeutic innovations may help to improve the current outcomes.