1
|
Khormi YH, Darraj AI, Arishy A, Abuzahirah SO, Atteya M. Bilateral Blunt Traumatic Dissections of the Extracranial Internal Carotid Artery: A Case Report and Literature Review. Cureus 2024; 16:e53630. [PMID: 38449976 PMCID: PMC10917072 DOI: 10.7759/cureus.53630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/05/2024] [Indexed: 03/08/2024] Open
Abstract
Bilateral traumatic dissections of the cervical internal carotid artery (ICA) are rare complications of polytrauma. A thorough literature review was performed, and data from selected studies were analyzed to assess the trends in clinical presentation, modes of trauma, management protocols, and clinical outcomes. The reported outcomes were categorized and graded into optimal, intermediate, and poor outcomes. We describe a rare case of bilateral dissection of ICA in a 31-year-old woman who was involved in a motor vehicle accident. She had a Glasgow Coma Scale score of 9 and right-sided hemiparesis. Radiological findings revealed left upper ICA dissection, arterial intramural thrombus, and stenosis of the upper segment of the right ICA. She improved on conservative management and had a good clinical outcome at a three-month follow-up. Emergency physicians must be knowledgeable about such cases, as more than half of these trauma victims are initially asymptomatic on initial presentation. Specific diagnostic and therapeutic modalities should be implemented based on low threshold clinical suspicion to avoid missing these potentially disabling injuries and reduce morbidity and mortality. Computed tomographic angiography is recommended in cases with atypical clinical presentations, unexplained neurological deficits, or delayed-onset clinical deterioration. While antiplatelet and anticoagulant therapies are the mainstays of conservative management, endovascular and surgical management are only used in severe cases when medical treatment has failed, the artery has been completely transected, or there is active bleeding. Generally, good outcomes were reported in about two-thirds of those patients.
Collapse
Affiliation(s)
| | | | | | - Seham O Abuzahirah
- Medicine and Life Sciences, Maastricht University, Netherlands, NLD
- Neurosurgery, King Fahad Hospital, Jeddah, SAU
| | - Mostafa Atteya
- Neurological Surgery, King Fahad General Hospital, Jazan, SAU
| |
Collapse
|
2
|
Pan YF, Liu ZJ, Zhang LB, Gao ZW, Chen B. Successful treatment of acute carotid artery injuries. World J Emerg Med 2023; 14:65-68. [PMID: 36713331 PMCID: PMC9842467 DOI: 10.5847/wjem.j.1920-8642.2023.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Accepted: 10/20/2022] [Indexed: 01/07/2023] Open
Affiliation(s)
- Yi-feng Pan
- Department of Vascular Surgery, the Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou 310009, China
| | - Zhen-jie Liu
- Department of Vascular Surgery, the Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou 310009, China
| | - Li-bin Zhang
- Department of Vascular Surgery, the Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou 310009, China
| | - Zhi-wei Gao
- Department of Vascular Surgery, the Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou 310009, China,Corresponding Author: Zhi-wei Gao, ; Bing Chen,
| | - Bing Chen
- Department of Vascular Surgery, the Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou 310009, China
| |
Collapse
|
3
|
Du F, Shao J, Lai Z, Li K, Wang C, Liu B. Case report: Traumatic carotid artery dissection after 7D High-Intensity Macro- and Micro-Focused Ultrasound treatment for skin laxity of the neck. Front Cardiovasc Med 2022; 9:913754. [PMID: 36061559 PMCID: PMC9433797 DOI: 10.3389/fcvm.2022.913754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Accepted: 06/03/2022] [Indexed: 12/24/2022] Open
Abstract
BackgroundTrauma is a relatively uncommon etiology of carotid artery dissection. Trauma is both penetrative and trivial, which can lead to carotid artery dissection. In the current study, we present an unusual case in which carotid artery dissection was potentially triggered by the damaging thermal effect of 7D High-Intensity Macro- and Micro-Focused Ultrasound (7D HIFU), which has been proposed as a safe and effective non-surgical modality for skin rejuvenation.Case summaryA 41-year-old woman developed headache and clinical manifestations of cerebral infarction after 7D HIFU, aimed at removing neckline. Head and neck magnetic resonance angiography (MRA) and computed tomography angiogram (CTA) revealed severe stenosis and dissection of the left internal carotid artery. Neither the patient's history nor the physical examination showed any special indicators. After resection of the left carotid artery dissection, autologous great saphenous vein interposition grafting, and simple mastoidectomy, the patient underwent head and neck MRA, which revealed recanalization of the left internal carotid artery.ConclusionAlthough mild or moderate complications of 7D HIFU, such as erythema, edema, transient dysesthesia, and motor nerve paresis, have been previously reported, a few previous literature studies documented severe complications of the cosmetic procedure. However, many recent studies pointed out the possibility of 7D HIFU damaging adjacent non-target tissues due to inadequate focal depth of HIFU treatment. Our case is the first to indicate that 7D HIFU could cause carotid artery dissection. We propose that better visualization systems and more rigorous operator training are needed to reduce the risk of the potential off-target damaging effect of 7D HIFU by reporting the case in which the damaging heat effect of 7D HIFU precipitated the carotid artery dissection HIFU.
Collapse
Affiliation(s)
- Fenghe Du
- Department of Vascular Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Science, Beijing, China
- Peking Union Medical College, Beijing, China
| | - Jiang Shao
- Department of Vascular Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Science, Beijing, China
| | - Zhichao Lai
- Department of Vascular Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Science, Beijing, China
| | - Kang Li
- Department of Vascular Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Science, Beijing, China
| | - Chaonan Wang
- Department of Vascular Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Science, Beijing, China
| | - Bao Liu
- Department of Vascular Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Science, Beijing, China
- *Correspondence: Bao Liu
| |
Collapse
|
4
|
Maiese A, Frati P, Manetti AC, De Matteis A, Di Paolo M, La Russa R, Turillazzi E, Frati A, Fineschi V. Traumatic Internal Carotid Artery Injuries: Do We Need a Screening Strategy? Literature Review, Case Report, and Forensic Evaluation. Curr Neuropharmacol 2022; 20:1752-1773. [PMID: 34254918 PMCID: PMC9881067 DOI: 10.2174/1570159x19666210712125929] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 04/05/2021] [Accepted: 06/01/2021] [Indexed: 11/22/2022] Open
Abstract
Internal carotid artery dissection (ICAD) represents the cause of ictus cerebri in about 20% of all cases of cerebral infarction among the young adult population. ICAD could involve the extracranial and intracranial internal carotid artery (ICA). It could be spontaneous (SICAD) or traumatic (TICAD). It has been estimated that carotid injuries could complicate the 0,32% of cases of general blunt trauma and the percentage seems to be higher in cases of severe multiple traumas. TICAD is diagnosed when neurological symptoms have already occurred, and it could have devastating consequences, from permanent neurological impairment to death. Thus, even if it is a rare condition, a prompt diagnosis is essential. There are no specific guidelines regarding TICAD screening. Nevertheless, TICAD should be taken into consideration when a young adult or middle-aged patient presents after severe blunt trauma. Understanding which kind of traumatic event is most associated with TICAD could help clinicians to direct their diagnostic process. Herein, a review of the literature concerning TICAD has been carried out to highlight its correlation with specific traumatic events. TICAD is mostly correlated to motor vehicle accidents (94/227), specifically to car accidents (39/94), and to direct or indirect head and cervical trauma (76/227). As well, a case report is presented to discuss TICAD forensic implications.
Collapse
Affiliation(s)
- Aniello Maiese
- Department of Surgical Pathology, Medical, Molecular and Critical Area, Institute of Legal Medicine, University of Pisa, 56126Pisa (PI), Italy; ,IRCSS Neuromed Mediterranean Neurological Institute, Via Atinense 18, 86077 Pozzilli (IS), Italy;
| | - Paola Frati
- IRCSS Neuromed Mediterranean Neurological Institute, Via Atinense 18, 86077 Pozzilli (IS), Italy; ,Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, Sapienza University of Rome, Viale Regina Elena 336, 00161 Rome (RM), Italy;
| | - Alice Chiara Manetti
- Department of Surgical Pathology, Medical, Molecular and Critical Area, Institute of Legal Medicine, University of Pisa, 56126Pisa (PI), Italy;
| | - Alessandra De Matteis
- Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, Sapienza University of Rome, Viale Regina Elena 336, 00161 Rome (RM), Italy;
| | - Marco Di Paolo
- Department of Surgical Pathology, Medical, Molecular and Critical Area, Institute of Legal Medicine, University of Pisa, 56126Pisa (PI), Italy;
| | - Raffaele La Russa
- IRCSS Neuromed Mediterranean Neurological Institute, Via Atinense 18, 86077 Pozzilli (IS), Italy; ,Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, Sapienza University of Rome, Viale Regina Elena 336, 00161 Rome (RM), Italy;
| | - Emanuela Turillazzi
- Department of Surgical Pathology, Medical, Molecular and Critical Area, Institute of Legal Medicine, University of Pisa, 56126Pisa (PI), Italy;
| | - Alessandro Frati
- IRCSS Neuromed Mediterranean Neurological Institute, Via Atinense 18, 86077 Pozzilli (IS), Italy; ,Neurosurgery Division, Human Neurosciences Department, Sapienza University of Rome, Rome, Italy
| | - Vittorio Fineschi
- IRCSS Neuromed Mediterranean Neurological Institute, Via Atinense 18, 86077 Pozzilli (IS), Italy; ,Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, Sapienza University of Rome, Viale Regina Elena 336, 00161 Rome (RM), Italy; ,Address correspondence to this author at the Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, Sapienza University of Rome, Viale Regina Elena 336, 00161 Rome (RM), Italy; E-mail:
| |
Collapse
|
5
|
Yap T, Feng L, Xu D, Zhang J. A near-fatal consequence of chiropractor massage: massive stroke from carotid arterial dissection and bilateral vertebral arterial oedema. BMJ Case Rep 2021; 14:14/8/e243976. [PMID: 34362754 PMCID: PMC8351484 DOI: 10.1136/bcr-2021-243976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
A 35-year-old Chinese man with no risk factors for stroke presented with a 2-day history of expressive dysphasia and a 1-day history of right-sided weakness. The presentation was preceded by multiple sessions of neck, shoulder girdle and upper back massage for pain relief in the prior 2 weeks. CT of the brain demonstrated an acute left middle cerebral artery infarct and left internal carotid artery dissection. MRI cerebral angiogram confirmed left carotid arterial dissection and intimal oedema of bilateral vertebral arteries. In the absence of other vascular comorbidities and risk factors, massage-induced internal carotid arterial dissection will most likely precipitate the near-fatal cerebrovascular event. The differential diagnosis of stroke in a younger population was consequently reviewed and discussed.
Collapse
Affiliation(s)
- Timothy Yap
- Curtin Medical School, Faculty of Health Sciences, Curtin University, Perth, Western Australia, Australia
| | - Li Feng
- Deaprtment of Neurology, First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Dan Xu
- Curtin Medical School, Faculty of Health Sciences, Curtin University, Perth, Western Australia, Australia .,Curtin School of Population Health, Faculty of Health Sciences, Curtin University Bentley Campus, Perth, Western Australia, Australia.,Medical Education & General Practice, First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Jian Zhang
- Deaprtment of Neurology, First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China
| |
Collapse
|
6
|
Salah K, van Werkum M, Derksen AM, Reijnen M, van Waarde J. Acute Dissection of the Carotid Artery After Electroconvulsive Therapy. Psychiatr Ann 2021. [DOI: 10.3928/00485713-20210603-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
|
7
|
Wang GM, Xue H, Guo ZJ, Yu JL. Cerebral infarct secondary to traumatic internal carotid artery dissection. World J Clin Cases 2020; 8:4773-4784. [PMID: 33195645 PMCID: PMC7642541 DOI: 10.12998/wjcc.v8.i20.4773] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 08/20/2020] [Accepted: 09/03/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Traumatic internal carotid artery dissection (TICAD) is rare and can result in severe neurological disability and even death. No consensus regarding its diagnostic screening and management has been established.
AIM To investigate the clinical presentation, imaging features, diagnostic workup, and treatment of TICAD.
METHODS In this retrospective case series, emergency admissions for TICAD due to closed head injury were analyzed. The demographic, clinical, and radiographic data were retrieved from patient charts and the picture archiving and communication system.
RESULTS Six patients (five males and one female, age range of 43-62 years, mean age of 52.67 years) presented with TICAD. Traffic accidents (4/6) were the most frequent cause of TICAD. The clinical presentation was always related to brain hypoperfusion. Imaging examination revealed dissection of the affected artery and corresponding brain infarction. All the patients were definitively diagnosed with TICAD. One patient was treated conservatively, one patient underwent anticoagulant therapy, two patients were given both antiplatelet and anticoagulant drugs, and two patients underwent decompressive craniectomy. One patient fully recovered, while three patients were disabled at follow-up. Two patients died of refractory brain infarction.
CONCLUSION TICAD can cause catastrophic outcomes and even refractory brain hernia. Early and efficient diagnosis of TICAD is essential for initiating appropriate treatment. The treatment of TICAD is challenging and variable and is based on clinician discretion on a case-by-case basis.
Collapse
Affiliation(s)
- Guang-Ming Wang
- Department of Neurosurgery, The First Hospital of Jilin University, Changchun 130021, Jilin Province, China
| | - Hang Xue
- Department of Neurosurgery, The First Hospital of Jilin University, Changchun 130021, Jilin Province, China
| | - Zhen-Jie Guo
- Department of Neurosurgery, The First Hospital of Jilin University, Changchun 130021, Jilin Province, China
| | - Jin-Lu Yu
- Department of Neurosurgery, The First Hospital of Jilin University, Changchun 130021, Jilin Province, China
| |
Collapse
|
8
|
Modified Split-Scan Computed Tomography (CT) Diagnostics of Severely Injured Patients: First Results from a Level I Trauma Center Using a Dedicated Head-and-Neck CT-Angiogram for the Detection of Cervical Artery Dissections. J Clin Med 2020; 9:jcm9082568. [PMID: 32784360 PMCID: PMC7464925 DOI: 10.3390/jcm9082568] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 08/06/2020] [Accepted: 08/06/2020] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Traumatic cervical artery dissections are associated with high mortality and morbidity in severely injured patients. After finding even higher incidences than reported before, we decided to incorporate a dedicated head-and-neck computed tomography angiogram (CT-A) in our imaging routine for patients who have been obviously severely injured or, according to trauma mechanism, are suspected to be severely injured. MATERIALS AND METHODS A total of 134 consecutive trauma patients with an ISS ≥ 16 admitted to our level I trauma center during an 18 month period were included. All underwent standardized whole-body CT in a 256-detector row scanner with a dedicated head-and-neck CT-A realized as single-bolus split-scan routine. Incidence, mortality, patient and trauma characteristics, and concomitant injuries were recorded and analyzed in patients with carotid artery dissection (CAD) and vertebral artery dissection (VAD). RESULTS Of the 134 patients included, 7 patients had at least one cervical artery dissection (CeAD; 5.2%; 95% CI 1.5-9.0%). Six patients (85.7%) had carotid artery dissections, with one patient having a CAD of both sides and one patient having a CAD and contralateral VAD combined. Two patients (28.6%) showed a VAD. Overall mortality was 14.3%, neurologic morbidity was 28.6%. None of the patients showed any attributable neurologic symptoms on admission. The new scanning protocol led to further 5 patients with suspected CeAD during the study period, all ruled out by additional magnetic resonance imaging with angiogram (MRI/MR-A). CONCLUSION A lack of specific neurologic symptoms on admission urges the need for a dedicated imaging pathway for severely injured patients, reliable for the detection of cervical artery dissections. Although our modified CT protocol with mandatory dedicated CT-A led to false positives requiring additional magnetic resonance imaging, it likely helped reduce possible therapeutic delays.
Collapse
|
9
|
Bilateral Traumatic Internal Carotid Artery Dissection after CrossFit Training. Ann Vasc Surg 2019; 61:466.e1-466.e5. [DOI: 10.1016/j.avsg.2019.04.028] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Revised: 03/20/2019] [Accepted: 04/11/2019] [Indexed: 11/20/2022]
|
10
|
Kaiser R, Saur K, Smolanka A, Ullas G, Beneš V. Type-III Hangman's fracture combined with serious cerebrovascular injury after near-hanging: a first case report and review of the literature. Br J Neurosurg 2019:1-4. [DOI: 10.1080/02688697.2019.1671952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Radek Kaiser
- Department of Neurosurgery and Neurooncology, First Faculty of Medicine, Charles University and Military University Hospital Prague, Prague, Czech Republic
| | - Karel Saur
- Department of Neurosurgery and Neurooncology, First Faculty of Medicine, Charles University and Military University Hospital Prague, Prague, Czech Republic
| | - Andriy Smolanka
- Regional Centre of Neurology and Neurosurgery, Uzhgorod, Ukraine
| | - Gautham Ullas
- Department of ENT, Cumberland Infirmary, North Cumbria University Hospitals NHS Trust, Carlisle, UK
| | - Vladimír Beneš
- Department of Neurosurgery and Neurooncology, First Faculty of Medicine, Charles University and Military University Hospital Prague, Prague, Czech Republic
| |
Collapse
|
11
|
Kasprzak D, Bojakowski K, Nowicki M, Zawadzki M, Andziak P. False Aneurysms Complicating Internal Carotid Artery Dissection. Vasc Endovascular Surg 2019; 53:259-263. [PMID: 30630394 DOI: 10.1177/1538574418823381] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Pseudoaneurysm formation is a rare but dangerous complication of carotid artery dissection. It can result from trauma, spontaneous artery dissection, or iatrogenic causes. Presence of symptoms and ineffective medical therapy are one of the indications for invasive treatment. We present the case of 3 symptomatic patients with dissecting pseudoaneurysms-2 traumatic and 1 spontaneous. They were treated with 3 different endovascular procedures: the use of covered stentgraft, trans-stent coil embolization, and carotid stenting. After invasive and dual antiplatelet therapy, complete resolution of symptoms was achieved in all patients.
Collapse
Affiliation(s)
- Dominika Kasprzak
- 1 Student's Scientific Group "Lusoria" at the Second Department of Vascular Surgery and Angiology, Centre of Postgraduate Medical Education, Central Clinical Hospital of the Ministry of Internal Affairs Warsaw, Warsaw, Poland
| | - Krzysztof Bojakowski
- 2 Second Department of Vascular Surgery and Angiology, Centre of Postgraduate Medical Education, Central Clinical Hospital of the Ministry of Internal Affairs, Warsaw, Poland
| | - Mirosław Nowicki
- 3 Department of Diagnostic and Interventional Radiology, Centre of Postgraduate Medical Education, Central Clinical Hospital of the Ministry of Internal Affairs, Warsaw, Poland
| | - Michał Zawadzki
- 3 Department of Diagnostic and Interventional Radiology, Centre of Postgraduate Medical Education, Central Clinical Hospital of the Ministry of Internal Affairs, Warsaw, Poland
| | - Piotr Andziak
- 2 Second Department of Vascular Surgery and Angiology, Centre of Postgraduate Medical Education, Central Clinical Hospital of the Ministry of Internal Affairs, Warsaw, Poland
| |
Collapse
|
12
|
Avila SV, Noy BV, Karsy M, Alexander M, Rolston JD. Bilateral blunt cerebrovascular injury resulting in direct carotid-cavernous fistulae: A case report and review of the literature. Surg Neurol Int 2018; 9:229. [PMID: 30568844 PMCID: PMC6262944 DOI: 10.4103/sni.sni_210_18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Accepted: 09/10/2018] [Indexed: 12/14/2022] Open
Abstract
Background Bilateral blunt cerebrovascular injury (BCVI) has been documented in 32 patients in the English-language literature and bilateral carotid-cavernous fistulae (CCFs) have been reported in only 1 patient. Here, we present a case of severe, unexpected bilateral BCVI with bilateral direct CCF and review the literature of BCVI, particularly cases of bilateral injury. Case Description A 65-year-old woman with episodic bradycardia presented after a motor vehicle accident. On arrival, she had a Glasgow Coma Scale of 3T and progressive dilation of her right pupil. Computed tomography imaging showed a 1.8-cm right epidural hematoma (EDH) with 6 mm of right-to-left shift. No acute skull-base fracture or injury in the area of the carotid canal was noted. The patient was treated with 3% hypertonic saline and mannitol before being taken to the operating room for emergent decompression of the hematoma. Although the patient initially presented with an EDH, significant intraoperative hemorrhage was identified during surgical evacuation and later confirmed as bilateral direct CCFs during angiographic evaluation. Because of the patient's devastating injuries, life-extending measures were not continued and the patient died. Conclusions A review of the literature indicates that bilateral CCFs are rare, having been reported only once previously. As this case demonstrates, CCFs may occur in high-energy injuries and should be considered even if the patient does not meet traditional screening criteria.
Collapse
Affiliation(s)
- Stephanie V Avila
- Department of Neurobiology and Anatomy, Clinical Neurosciences Center, Salt Lake City, Utah, USA
| | - Brooke Van Noy
- Department of Neurobiology and Anatomy, Clinical Neurosciences Center, Salt Lake City, Utah, USA
| | - Michael Karsy
- Department of Neurosurgery, Clinical Neurosciences Center, Salt Lake City, Utah, USA
| | - Matthew Alexander
- Department of Radiology, University of Utah, Salt Lake City, Utah, USA
| | - John D Rolston
- Department of Neurosurgery, Clinical Neurosciences Center, Salt Lake City, Utah, USA
| |
Collapse
|
13
|
Taoussi N, Alghamdi A, Bielewicz J, Luchowski P, Rejdak K. Traumatic bilateral dissection of cervical internal carotid artery in the wake of a car accident: A case report. Neurol Neurochir Pol 2017; 51:432-438. [DOI: 10.1016/j.pjnns.2017.07.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2017] [Revised: 05/13/2017] [Accepted: 07/03/2017] [Indexed: 11/29/2022]
|
14
|
Jenkins JM, Norton J, Hampton T, Weeks R. Rare case of bilateral traumatic internal carotid artery dissection. BMJ Case Rep 2016; 2016:bcr-2016-217262. [PMID: 27651410 DOI: 10.1136/bcr-2016-217262] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
A 55-year-old man was working in a trench when the wall collapsed in on him, pinning him to the wall. On arrival in the emergency department the patient began reporting of right-sided headache. Neurological examination revealed left-sided reduced sensation with weakness. Whole-body CT scan showed right-sided flail chest and bilateral haemothorax as well as loss of flow and thinning of the distal right internal carotid artery (ICA) and loss of grey white matter differentiation in keeping with traumatic ICA dissection with a right middle cerebral artery (MCA) infarct. He was started on aspirin 300 mg once daily. 3 days postadmission the patient experienced worsening of vision and expressive dysphasia. CT angiogram showed bilateral ICA dissections extending from C2 to the skull base. The patient was managed conservatively in the stroke unit for infarction and was discharged home for follow-up in stroke clinic.
Collapse
Affiliation(s)
| | | | - Timothy Hampton
- Department of Neuroradiology, King's College Hospital, London, UK
| | - Robert Weeks
- Department of Neuroradiology, King's College Hospital, London, UK
| |
Collapse
|
15
|
Bajkó Z, Bălaşa R, Moţăţăianu A, Bărcuţean L, Stoian A, Stirbu N, Maier S. Malignant Middle Cerebral Artery Infarction Secondary to Traumatic Bilateral Internal Carotid Artery Dissection. A Case Report. ACTA ACUST UNITED AC 2016; 2:135-141. [PMID: 29967852 DOI: 10.1515/jccm-2016-0021] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2016] [Accepted: 05/30/2016] [Indexed: 01/18/2023]
Abstract
Traumatic bilateral dissection of the carotid arteries is a rare condition with potentially life-threatening complications. The case of a 57-year-old male patient with acute onset left sided hemiparesis, twelve hours after a blunt head injury, caused by a horse kick, is reported. A cerebral CT scan revealed right middle cerebral artery (MCA) territory infarction. Based on Duplex ultrasound and Angio CT scan findings, a diagnosis of bilateral ICA dissection was established. Despite antithrombotic treatment, the patient presented with a progressive worsening of his neurological status. The control CT scan evidenced malignant right MCA territory infarction that required decompressive craniotomy. The patient was discharged with significant neurological deficits. Together with this case, the aetiologies, clinical manifestations, diagnostic and therapeutical options and outcome of carotid artery dissection are discussed.
Collapse
Affiliation(s)
- Zoltán Bajkó
- University of Medicine and Pharmacy Târgu Mureş, Department of Neurology, Târgu Mureş, Romania
| | - Rodica Bălaşa
- University of Medicine and Pharmacy Târgu Mureş, Department of Neurology, Târgu Mureş, Romania
| | - Anca Moţăţăianu
- University of Medicine and Pharmacy Târgu Mureş, Department of Neurology, Târgu Mureş, Romania
| | - Laura Bărcuţean
- University of Medicine and Pharmacy Târgu Mureş, Department of Neurology, Târgu Mureş, Romania
| | - Adina Stoian
- University of Medicine and Pharmacy Târgu Mureş, Department of Pathophysiology, Târgu Mureş, Romania
| | | | - Smaranda Maier
- University of Medicine and Pharmacy Târgu Mureş, Department of Neurology, Târgu Mureş, Romania
| |
Collapse
|
16
|
Galyfos G, Filis K, Sigala F, Sianou A. Traumatic Carotid Artery Dissection: A Different Entity without Specific Guidelines. Vasc Specialist Int 2016; 32:1-5. [PMID: 27051653 PMCID: PMC4816018 DOI: 10.5758/vsi.2016.32.1.1] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2016] [Accepted: 03/11/2016] [Indexed: 12/12/2022] Open
Abstract
According to literature data, there are no distinct guidelines regarding the proper diagnostic and therapeutic management of traumatic carotid artery dissection (TCAD). Although most of cases evaluated in research studies refer to spontaneous carotid artery dissection, traumatic cases demand special considerations as far as diagnosis and treatment are concerned. Although both types of dissection share some common characteristics, a patient with TCAD usually presents with several concomitant injuries as well as a higher bleeding risk, thus complicating decision making in such patients. Therefore, aim of this review is to present available data regarding epidemiology, clinical presentation, diagnostics and treatment strategy in cases with TCAD in order to produce useful conclusions for everyday clinical practice.
Collapse
Affiliation(s)
- George Galyfos
- Vascular Division, First Propedeutic Department of Surgery, Hippocration Hospital, Athens, Greece
| | - Konstantinos Filis
- Vascular Division, First Propedeutic Department of Surgery, Hippocration Hospital, Athens, Greece
| | - Fragiska Sigala
- Vascular Division, First Propedeutic Department of Surgery, Hippocration Hospital, Athens, Greece
| | - Argiri Sianou
- Department of Microbiology, Areteion University Hospital, Athens, Greece
| |
Collapse
|
17
|
Iacobellis F, Ierardi AM, Mazzei MA, Magenta Biasina A, Carrafiello G, Nicola R, Scaglione M. Dual-phase CT for the assessment of acute vascular injuries in high-energy blunt trauma: the imaging findings and management implications. Br J Radiol 2016; 89:20150952. [PMID: 26882960 DOI: 10.1259/bjr.20150952] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Acute vascular injuries are the second most common cause of fatalities in patients with multiple traumatic injuries; thus, prompt identification and management is essential for patient survival. Over the past few years, multidetector CT (MDCT) using dual-phase scanning protocol has become the imaging modality of choice in high-energy deceleration traumas. The objective of this article was to review the role of dual-phase MDCT in the identification and management of acute vascular injuries, particularly in the chest and abdomen following multiple traumatic injuries. In addition, this article will provide examples of MDCT features of acute vascular injuries with correlative surgical and interventional findings.
Collapse
Affiliation(s)
- Francesca Iacobellis
- 1 Department of Diagnostic Imaging, Pineta Grande Medical Center, Castel Volturno, Italy.,2 Department of Radiology, Second University of Naples, Naples, Italy
| | - Anna M Ierardi
- 3 Interventional Radiology Department, Radiology Unit, University of Insubria, Varese, Italy
| | - Maria A Mazzei
- 4 Department of Surgical Sciences, Azienda Ospedaliera Universitaria Senese, University of Siena, Siena, Italy
| | | | - Gianpaolo Carrafiello
- 3 Interventional Radiology Department, Radiology Unit, University of Insubria, Varese, Italy
| | - Refky Nicola
- 6 Division of Emergency Imaging, Department of Imaging Sciences, University of Rochester Medical Center, Rochester, NY, USA
| | - Mariano Scaglione
- 1 Department of Diagnostic Imaging, Pineta Grande Medical Center, Castel Volturno, Italy.,7 Department of Radiology, Darent Valley Hospital, Dartford and Gravesham NHS Trust, Dartford, UK
| |
Collapse
|