J Korean Neurotraumatol Soc.  2009 Jun;5(1):25-28. 10.13004/jknts.2009.5.1.25.

Internal Carotid Artery Dissecting Aneurysm by Violence: A Case Report

• Kang SH
• Lee ES

• KMID: 2019930
• DOI: http://doi.org/10.13004/jknts.2009.5.1.25

Abstract

Dissecting aneurysm is not common. By the literature, motorcycle accidence is most common cause of dissecting aneurysm. Next to motorcycle accidence, perforating injury or blunt traumas occasionally could cause the dissection of artery. The authors have experienced one young adult man who admitted emergency room (ER) because of loss of consciousness, left hemiparesis and headache after violence of neck trampled down. On radiologic study, right carotid arterial dissection and acute cerebral infarction of middle cerebral artery territory were detected. Because of hemorrhagic transformation with severe brain swelling, he got decompressive craniectomy and carotid stent insertion in consecutive order. The authors present a case of carotid dissecting aneurysm after minor violence and careful observation was needed to identify.

Keyword

Dissecting aneurysm; Violence

MeSH Terms

Aneurysm, Dissecting
Arteries
Brain Edema
Carotid Artery, Internal
Cerebral Infarction
Decompressive Craniectomy
Emergencies
Headache
Humans
Middle Cerebral Artery
Motorcycles
Neck
Paresis
Stents
Unconsciousness
Violence
Young Adult

Figure

• 

  FIGURE 1 Initial brain computer tomography (CT) taken 3 hours after violence demonstrated subarachnoid hemorrhage (arrow) on right Sylvian fissure.

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  FIGURE 2 Brain magnetic resonance Imaging (MRI) taken 2 days after violence. T1W (A), T2W (B), FLAIR (C) and diffusion (D) demonstrate acute ischemia of right Middle Cerebral Arterial (MCA) territory. FLAIR: fluid attenuated inversion recovery.

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  FIGURE 3 Digital subtraction angiography (DSA). A, B: Showing contrast defect (arrow) of ICA. C, D: 3 dimensional reconstruction of DSA demonstrate a distal extracranial internal carotid dissection (arrow). ICA: internal carotid artery.

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  FIGURE 4 Digital subtraction angiography (DSA) taken 2 weeks later. A, B: DSA demonstrated aggravation of carotid dissection (arrow). C, D: DSA demonstrated carotid stent had inserted and blood flow improved (arrow).

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