Deconstructing Dissections: A Case Report and Review of Blunt Cerebrovascular Injury of the Neck

Case Reports in Emergency Medicine
Brittany A WalshJessica S Whittle

Abstract

Blunt cerebrovascular injury (BCVI) is a term encompassing traumatic carotid and vertebral artery dissection or disruption. While the reported incidence appears to be increasing as diagnostic modalities improve, these injuries are often diagnosed only after patients have developed acute neurologic symptoms. These injuries often result in severe permanent neurologic disability or death. The gold standard for diagnosis has historically been a 4-vessel arteriogram. However, newer data are suggesting that computed tomographic angiography may be more appropriate for most patients and new criteria for its utilization have been developed. We report a case of bilateral carotid dissection in a 23-year-old woman involved in a motor vehicle collision (MVC). She initially presents with a normal neurologic exam and two hours later develops hemiparesis. She is treated with antiplatelet therapy and given intravascular catheter directed tissue plasminogen activator with carotid stent placement. Nonetheless, the patient goes on to require intubation and, ultimately, a tracheostomy and transfer to an inpatient rehabilitation setting due to continued hemiparesis. This case highlights the need for increased awareness of a potentially debilitating,...Continue Reading

References

May 1, 1996·Annals of Surgery·T C FabianF E Pritchard
Feb 12, 2000·American Journal of Surgery·W L BifflJ M Burch
Aug 9, 2001·The Journal of Trauma·P R MillerM A Croce
Oct 12, 2004·Emergency Medicine Clinics of North America·William E Baker, Jonathan Wassermann
May 18, 2005·Archives of Surgery·C Clay CothrenJon M Burch
Feb 9, 2012·The Journal of Trauma and Acute Care Surgery·Laura E AveryJason L Sperry
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Mar 26, 2016·The Journal of Trauma and Acute Care Surgery·Charles P ShahanTimothy C Fabian

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BETA
dissection

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