Korean J Neurotrauma.  2018 Apr;14(1):28-31. 10.13004/kjnt.2018.14.1.28.

Common Carotid Artery Dissection in Multiple Extracranial Injury: A Case Report

• Kil JS
• Lee MK
• Eom KS

• KMID: 2410918
• DOI: http://doi.org/10.13004/kjnt.2018.14.1.28

Abstract

Traumatic common carotid artery dissection (CCAD) is rare. To our knowledge, only 14 case reports have described traumatic CCAD previously. Here, we report a case of CCAD in a patient with severe trauma. A 50-year-old man was lying on the road after drinking alcohol when a car drove over him. Computed tomography (CT) revealed multiple rib fractures with hemopneumothorax, lung contusion, flail chest, large amount of hematoma with bladder rupture, and fractures on the C6 spinous process, sacral ala, iliac bone, and pubic ramus. Repair of the bladder rupture, exploratory thoracotomy, and open reduction of multiple rib fractures were performed. Right side hemiparesis was observed on hospital day 4. Brain CT showed a large acute left middle cerebral artery infarction. CT angiography showed focal carotid dissection at the left common carotid artery with intimal flap. The CCAD was located at the C6 level. Clexane (enoxaparin sodium) treatment was initiated. An abdominal CT scan revealed a huge retroperitoneal hematoma and increased amount of hematoma in the prevesical and perivesical space, 10 days later. The patient died two days later. Although traumatic CCAD is rare, this case report provides useful information for trauma surgeons regarding the treatment and diagnosis of similar cases.

Keyword

Common carotid artery; Dissection; Traumatic carotid dissection

MeSH Terms

Angiography
Brain
Carotid Artery, Common*
Contusions
Deception
Diagnosis
Drinking
Enoxaparin
Flail Chest
Hematoma
Hemopneumothorax
Humans
Infarction, Middle Cerebral Artery
Lung
Middle Aged
Paresis
Rib Fractures
Rupture
Surgeons
Thoracotomy
Tomography, X-Ray Computed
Urinary Bladder
Enoxaparin

Figure

• 

  FIGURE 1 Brain computed tomography showing no significant lesions, such as hematoma, fracture.

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  FIGURE 2 Brain computed tomography showing large diffuse acute left middle cerebral artery infarction with mild mass effect.

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  FIGURE 3 (A) Computed tomography (CT) angiography showing focal carotid dissection (white arrow) at the left common carotid artery with intimal flap. Common carotid artery dissection (CCAD) is located 2 cm proximal from the carotid bifurcation. The lesion is located at the lower part of the carotid CT angiographic image. (B) Axial image showing intimal flap of CCAD (white arrow). C6 spinous process fracture (asterisk) is also seen on the same image.

• 

  FIGURE 4 Computed tomography angiography showing almost normal vascularity of the left middle cerebral artery.

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