Traumatic Internal Carotid Artery Dissection Research Articles

History of Spontaneous Dissection of the Cervical Carotid Artery

J ean Fernelius (Fernel), a French mathematician, astronomer, and physician, probably reported the earliest description of a patient with a dissection of the aorta in 1542. Although many clinical syndromes related to vascular lesions were described in the 19th and early 20th centuries, dissection of the carotid arteries was not documented until the mid 1900s. The first aortic dissections extending into the internal carotid artery were described by Shennan in 1934. Dratz and Woodhall published the first description of a patient with traumatic dissection of the internal carotid artery in 1947. Two further cases of traumatic internal carotid artery dissection due to cranial extension of common carotid artery dissection, a well-known complication of carotid puncture during cerebral angiography, were reported in 1954.

Intraarterial Thrombolysis and Stent Placement in the Acute Phase of Blunt Internal Carotid Artery Trauma with Subocclusive Dissection and Thromboembolic Complication: Case Report and Review of the Literature

The case of a patient with blunt traumatic internal carotid artery dissection associated with subocclusive stenosis and thromoboembolic complication is presented. The patient suffered fluctuant neurological abnormalities and several open and closed fractures of the left limb. The vascular lesion and its complication were successfully treated with intraarterial thrombolysis and stent placement during the acute phase, prior to the open surgical treatment of the fractures.

HWS-Syndrom bei einem Triathleten? - Die traumatische Karotisdissektion als seltene Differenzialdiagnose

Most cervical artery dissections occur spontaneously, but traumatic mechanisms can occasionally be identified. Traumatic internal carotid artery dissection has been attributed with several sports, but there are no reports of its occurrence in thriathlon. We report the case of a 63-year-old semi-professional triathlete, who noticed right-sided neck pain and parietooccipital headache after a triathlon competition. Neurological examination revealed an incomplete right Horner's syndrome. MRI and MR-angiography demonstrated a right-sided internal carotid artery dissection with segmental loss of flow-signal and a mural haematoma in the vessel wall. In this case two pathophysiological mechanisms may be considered. Our patient reported receiving several blows to the neck in a congested 50-metre pool during the triathlon swimming stage. Furthermore, the hyperextended position of the neck during the subsequent cycling stage may have contributed, to a large extent, to the arterial dissection. The risk factors, presenting symptoms, diagnosis of internal carotid artery dissection are reviewed.

Minor Trauma May Lead to Traumatic Internal Carotid Artery Dissection

A farmer's wife was slapped by her cow's tail during milking. There was no obvious injury, but afterward she first developed unusual headaches of unknown origin and then a severe stroke 7 days later. Further diagnostics, including magnetic resonance imaging techniques, revealed a dissection of the carotid artery to be the reason for the stroke, probably caused by being hit by the cow's tail. This case demonstrates that persisting unusual headaches, even after minor trauma, should lead to further diagnostic procedures and then therapeutic intervention for stroke prevention if necessary.

Carotid Dissection Associated with a Handheld Electric Massager

The extracranial internal carotid artery (ICA) is susceptible to injury and dissection from external shear forces applied to the neck. Traumatic ICA dissection usually occurs in the setting of a sudden, high amplitude force causing significant distortion of surrounding soft tissues. Weaker, repetitive forces applied for longer intervals may also pose a risk for ICA dissection. A 38-year-old woman with no significant stroke risk factors had sudden onset of severe dysarthria and left hemiparesis several days after receiving an approximately 20-minute neck massage with a handheld electric massager. The moving elements consisted of two approximately 2-cm-diameter spheres that percuss the skin with low amplitude and high frequency. Magnetic resonance imaging and angiography demonstrated acute infarction in the right middle cerebral artery territory and dissection of the extracranial right ICA. Handheld electric massager units may cause ICA dissection and disabling stroke.

Traumatic Carotid Artery Dissection Causing Blindness

A case of delayed postoperative visual loss due to bilateral traumatic carotid artery dissection is presented. In patients with a major craniofacial injury due to a high-speed motor vehicle accident, we suggest that carotid artery duplex ultrasonography be used in the initial evaluation for possible carotid artery dissection. Magnetic resonance imaging of the head and neck with magnetic resonance angiography should be performed subsequently if indicated. Early diagnosis and initiation of therapy can minimize complications.

Cerebral Infarction due to Traumatic Internal Carotid Artery Dissection : a casereport and Review of the Literature

Cerebral Infarction due to Traumatic Internal Carotid Artery Dissection : a casereport and Review of the Literature

Long-term graft patency rates and clinical outcomes after revascularization for symptomatic traumatic internal carotid artery dissection.

Surgical management of traumatic internal carotid artery (ICA) dissection remains controversial. Therefore, the delayed outcomes and graft patency rates of patients who underwent bypass procedures for symptomatic traumatic ICA dissection were studied. Between September 1989 and August 1996, 13 patients (9 male and 4 female patients; mean age, 30.6 yr) underwent 16 revascularization procedures for symptomatic traumatic ICA dissection. The duration of clinical follow-up averaged 47.3 months (range, 12-94 mo) from the date of diagnosis. The duration of radiographic follow-up (catheter or magnetic resonance angiography, duplex Doppler ultrasonography) averaged 24 months (range, 12-60 mo). ICA dissection was caused by blunt (n = 11) or penetrating trauma (n = 2). Associated angiographic abnormalities included seven ipsilateral ICA occlusions, six dissecting aneurysms, two carotid-cavernous fistulae, and six contralateral traumatic ICA dissections. Patients requiring early revascularization (n = 6) underwent bypass procedures an average of 19.2 days after their injuries. Medically managed patients who developed ischemia later were revascularized a mean of 7.8 months after injury. The mean Glasgow Coma Scale score at the time of presentation was 10 (range, scores of 6-15), and the mean Glasgow Coma Scale score before revascularization was 14 (range, scores of 9-15). There were 14 saphenous vein ICA bypasses (8 cervical-to-petrous, 3 cervical-to-middle cerebral artery, 3 petrous-to-supraclinoid) and 2 superficial temporal artery-to-middle cerebral artery bypasses. There was one early postoperative graft occlusion, which responded to surgical thrombectomy. One patient with multiple other traumatic injuries died as a result of a pulmonary embolus 12 months after revascularization. All remaining patients had Glasgow Outcome Scale scores of 5, with patent bypass grafts confirmed during follow-up. Revascularization for persistently symptomatic traumatic ICA dissection eliminated ischemia and was associated with excellent long-term outcomes and graft patency rates.

Long-term Graft Patency Rates and Clinical Outcomes after Revascularization for Symptomatic Traumatic Internal Carotid Artery Dissection

Long-term Graft Patency Rates and Clinical Outcomes after Revascularization for Symptomatic Traumatic Internal Carotid Artery Dissection

Long-term Graft Patency Rates and Clinical Outcomes after Revascularization for Symptomatic Traumatic Internal Carotid Artery Dissection

Long-term Graft Patency Rates and Clinical Outcomes after Revascularization for Symptomatic Traumatic Internal Carotid Artery Dissection

Long-term Graft Patency Rates and Clinical Outcomes after Revascularization for Symptomatic Traumatic Internal Carotid Artery Dissection

Long-term Graft Patency Rates and Clinical Outcomes after Revascularization for Symptomatic Traumatic Internal Carotid Artery Dissection

Long-term Graft Patency Rates and Clinical Outcomes after Revascularization for Symptomatic Traumatic Internal Carotid Artery Dissection

Long-term Graft Patency Rates and Clinical Outcomes after Revascularization for Symptomatic Traumatic Internal Carotid Artery Dissection

Traumatic internal carotid artery dissections caused by blunt softball injuries

This report describes recently treated patients with carotid artery dissection caused by blunt softball injuries, as well as the results of a study of carotid artery trauma in a community. Data obtained through the medical records linkage system used for epidemiologic studies in Olmsted County, MN were used to identify all cases of traumatic internal carotid artery dissection diagnosed from 1987 through 1994. Four patients with traumatic internal carotid artery dissections were identified during the 8-year period under study. In two patients (50%) the carotid dissection was a result of the direct impact of a softball. A 39-year-old-man, who developed transient cerebral ischemic symptoms, and a 35-year-old woman, who developed a painful Horner's syndrome, were struck by a softball on the anterolateral aspect of the neck. Both patients had a low carotid bifurcation. These data suggest that internal carotid artery dissections may be underrecognized sequelae of direct softball injuries to the anterolateral neck. A low carotid bifurcation may be a risk factor for such injuries.

Diagnosis of traumatic carotid artery dissection by transcranial Doppler ultrasound: Case report and review of the literature

The clinical course, transcranial Doppler ultrasound (TCD) findings, and angiographic outcome are reported for a patient with a traumatic carotid artery dissection. Transient asymmetrical decreased middle cerebral artery blood flow velocities led to the suspicion of an internal carotid artery (ICA) stenosis. Duplex scanning and angiography subsequently demonstrated an extracranial traumatic ICA dissection in combination with a traumatic saccular aneurysm. These data imply that TCD monitoring has a potential to diagnose not only well established complications of neurotrauma, such as vasospasm and intracranial hypertension, but may also suggest the presence of traumatic extracranial carotid obstructions.

Bilateral traumatic internal carotid artery dissections: Case report

Bilateral traumatic internal carotid artery dissections: Case report

Bilateral traumatic internal carotid artery dissections: Case report

Bilateral internal carotid artery dissections after blunt cervicofacial trauma are rare, with 16 cases being previously published. Management is presumed to be an extension of the dominant therapy for unilateral dissection, that being anticoagulant therapy; however, bilateral stenoses engender questions of threat to total cerebral blood flow. We herein present a patient who suffered bilateral type B dissections and who then had progression of the process on anticoagulant therapy, resulting in an unusual carotid reconstruction.

Carotid Artery Dissection Secondary to Seatbelt Trauma

A postmortem report of a patient with traumatic internal carotid artery dissection, along with evidence strongly suggestive of a car seatbelt as a causative factor, is presented. In this 5-foot subject, the shoulder harness could have been high, over the anterior cervical area. The authors feel this mechanism deserves consideration as one of the important causes of traumatic carotid dissection. If supported by further studies, remedial measures in the form of changes in seatbelt design, or the use of alternate protective measures may be warranted.