A case report of successful antithrombotic therapy for a patient with delayed blunt traumatic extracranial internal carotid dissection

Abstract

We describe a patient who developed blunt traumatic extracranial internal carotid artery dissection with delayed symptoms.
A 54-year-old man was admitted to our hospital with right leg paralysis two months after a traffic injury. Cerebral angiography revealed severe stenosis of the left petrous internal carotid artery (ICA). Aphasia and left hemiparesis developed after admission. A cerebral angiogram showed progressive arterial stenosis and thrombus on day 4. Acute embolic infarctions were evident on diffusion-weighted MRI and cerebral blood flow in the left ICA area was decreased on SPECT. We diagnosed ischemic stroke with ICA dissection caused by the traffic injury 2 months previously. Artery-to-artery embolism with hemodynamic compromise was suggested by MRI and SPECT findings. Although the left ICA finally became occluded, hypervolemic and antithrombotic therapy improved the neurological symptoms.
Cerebral infarction due to cervical artery dissection can develop even several months after traffic accidents that apparently cause symptoms of only slight neck sprain.