Traumatische Dissektion der A. carotis interna nach HWS-Beschleunigungstrauma

Abstract

We report on the case of a 33-year-old male patient who was brought to the emergency room of our hospital after suffering a high-energy trauma due to an automobile accident. Besides a scaphoid fracture there were no signs of any neurological deficits. After several hours without clinical symptoms the patient developed dysarthria as the first manifestation of local cerebral ischemia based on a traumatic dissection of the internal carotid artery. Under systemic high-dose heparin therapy, fast and complete remission of all neurological disorders could be achieved. In the course of time a dissecting aneurysm developed. Temporary anticoagulation with phenprocoumon was started in the meantime and no further complications have appeared up to now. Besides presenting this absorbing case, this article highlights the diagnostic and therapeutic regime in cases of a traumatic dissection of supra-aortal arteries for rapid and adequate management of this rare but potentially dangerous complication.

Traumatic bilateral carotid artery dissection following severe blunt trauma: a case report on the difficulties in diagnosis and therapy of an often overlooked life-threatening injury

“…Distraction/extension, distraction/flexion or lateral flexion forces of the C-spine may result in traumatic ICA dissections [2, 5]. Even a vasocompression between C-Spine and mandibula during a hyperinclination trauma can lead to a dissection of the internal carotid artery (ICA) [1, 2]. These mechanisms are frequently seen in MVAs, where the car occupants remain fixed in their seats by the security belt during a sudden loss of speed (i.e.…”

“…The mentioned forces may cause small lesions of the vessel wall, which can result in intimal tears, intramural hematomas or complete lumen displacement [2, 4]. It is reasonable for cerebral ischemic insults to activate the coagulation cascade, which results in thrombus formation and, concomitantly, in an increased risk of thromboembolic cerebral insults [1, 2, 6]. …”

“…Duplex ultrasound is one of the non-invasive methods with a high disposability even in smaller hospitals. It is a common method to detect cerebrovascular injuries [1], although it has certain limits when it comes to acute traumatic dissections in major injuries: it is an operator-dependent method with poor vision of the intracranial aspects of a dissection and it also gives limited information about small intimal tears [6]. When it comes to dissections of the ICA as described in our case, the sensitivity of diagnostic ultrasound is even lower [9, 10].…”

“…brain injuries, fractures, etc.) [1, 6, 13, 14]. But it also has certain limits, especially during the diagnostic of critically injured patients in the trauma room.…”

“…Traumatic carotid artery dissections are often overlooked life-threatening injuries [1]. Even though most of the carotid artery dissections occur spontaneously, about 4% of the dissections are related to severe trauma [2].…”