Low velocity traumatic dissection of the internal carotid artery presenting as a stroke after a slash injury

Agrawal A, Kumar A, Tiwari A, Sinha A, Patel A
Correspondence: Dr Amit Agrawal, dramitagrawal@gmail.com

ABSTRACT
Low velocity traumatic dissection of the carotid artery is an infrequent but serious complication of blunt cranio-cervical injury. A 25-year-old man was hit by a blunt sickle over his chest and left side of his neck, and sustained open wounds over zone II of the neck. At that time, he had no neurological deficits and the wounds were sutured primarily. On the sixth day, while he was undergoing a change of dressing for the wounds, he suddenly became unconscious, and on recovery hours later, he was aphasic. Computed tomography showed a left posterior fronto-temporal ischaemic infarct in the territory of the middle cerebral artery. Colour Doppler ultrasonography showed an intimal tear and thrombus in the left common carotid artery. We discuss the possible mechanism of neurological deficits and also emphasise that in any patient with blunt injury to the neck, new neurological deficits should prompt us to suspect carotid artery injuries.

Keywords: carotid artery dissection, embolic stroke, neck injury complication, neurological deficit, stroke
Singapore Med J 2007; 48(5): e127–e129