Abstract
A boy aged 11 years sustained a small laceration on the left ear after being struck with a ski-pole. Three hours later, he suffered progressive nausea, vomiting, right hemiparesis, aphasia, and disturbance of consciousness resulting from thrombosis of the left internal carotid artery at the upper cervical level. He was examined extensively by computed tomography, but at the early stage of the clinical course, head computed tomography revealed minimal low density area and little mass effect except in the cavum Vergae and cavum septi pellucidi. He died 62 hours after the trauma. A correct diagnosis has rarely been made at an initial stage of the clinical course of this type of trauma. The clinical and diagnostic pitfalls of this complication are discussed and the literature is reviewed. This complication should be considered whenever a patient who has suffered cervical trauma exhibits progressive neurological deterioration without intracranial hematoma, and retains a relatively good level of consciousness. Magnetic resonance image and digital subtraction angiography may be a choice in future to verify the diagnosis at an early stage because they are safe and reliable non-invasive methods.
