Trombose da artéria carótida interna devida a trauma penetrante no pálato mole: relato de caso

Abstract

RESUMO -Descrevemos caso de trauma penetrante na região oral em criança, evoluindo com oclusão da artéria carótida interna e déficit neurológico correspondente. A tomografia computadorizada e a ressonância nuclear magnética demonstram a oclusão completa da artéria carótida interna. Enfatizamos esta rara complicação de trauma oral, comum em crianças e discutimos os aspectos patogênicos.PALAVRAS-CHAVE: trauma oral, artéria carótida interna, trombose, oclusão, infarto, artéria cerebral média, aneurisma dissecante. Thrombosis of the internal carotid artery secondary to soft palate injury: case reportABSTRACT-Stroke following intraoral trauma is a rare complication of a common childhood injury. In the literature these complications have been well documented, however this condition is still infrequent. In order to alert the physicians about this possible injury we report our experience with one case. Computer tomography and magnetic resonance imaging evidenced complete occlusion of the internal carotid artery. Pathogenesis of this oral trauma is discussed.KEY WORDS: oral injury, internal carotid artery, thrombosis, stroke, occlusion, middle cerebral artery, dissecting aneurysm O ferimento na região palatina lateral ou peritonsilar pode ser benigno, aparentemente. A trombose da artéria carótida interna (ACI), resultante de trauma na região do palato mole e da região peritonsilar lateral é situação relativamente rara, grave, de proporções catastróficas em muitas das vezes 1 . As manifestações neurológicas ocorrem tardiamente num período de 1 a 60 horas decorridas do acidente [2][3][4] . As sequelas vão desde déficits mínimos à morte, ocorrendo esta em até 30% dos casos 3 .Relatamos caso de nossa experiência.

Thrombosis of the Internal Carotid Artery Secondary to Soft Palate Injury in Children and Childhood

“…The artery injury may be due to direct or indirect shearing forces applied to the artery wall [7]leading to endothelial disruption and thrombosis [1, 3, 4, 7, 8, 9]. Therefore, neurologic symptoms may flourish, even when the abrasions seem harmless, by distal embolization from ICA thrombus fragmentation.…”

“…Neurologic symptoms have been described to appear 1–60 h posttrauma [1, 3, 4, 6], which may reflect the migration of thrombus fragments [10]. ICA complete occlusion could be compensated by Willis polygon patency, and no deficit would then be found.…”

“…In this special situation, injuries to the hard and soft palate may evolve. Internal carotid artery (ICA) occlusion after soft palate and peritonsillar trauma is a serious complication with a very detrimental outcome [1, 2]. The clinical picture after trauma may seen unremarkable despite minor abrasions observed in oral examination.…”

“…The clinical picture after trauma may seen unremarkable despite minor abrasions observed in oral examination. Severe neurologic deficit may later manifest with an onset of 1–60 h after the trauma [1, 2, 3, 4]. Neurologic impairment may be diverse, and deficits may persist, ranging from minor motor awkwardness to death.…”