Blunt traumatic carotid artery occlusion (BTCAO) is extremely rare and has been reported in 0.03–0.04% of all cases of blunt trauma to the carotid artery. We report three cases of BTCAO.
Case 1: The patient presented with mild diplopia and significant bruising of his left anterior neck, following a car wreck in which he was injured by the steering wheel. Magnetic resonance imaging (MRI) revealed a small brainstem infarct, and MR angiography (MRA) revealed left common carotid artery (CCA) occlusion. Angiography performed on day 3 revealed reappearance of the left internal carotid artery (ICA) from the bifurcation via collateral circulation. The CCA was ligated to avoid further embolic complications, and he was discharged without any neurological deficits.
Case 2: The patient presented with left hemiplegia in a semicomatose state, following a serious head injury after a fall from the rooftop. Initial computed tomography (CT) revealed cerebral contusion and traumatic subarachnoid hemorrhage (SAH) with multiple skull and skull base fractures including right sphenoid sinus wall. CT performed on day 2 revealed a large area of cerebral infarction in the right cerebral hemisphere, and we performed decompressive craniotomy. MRA performed on day 14 revealed right ICA occlusion. He was transferred to the rehabilitation hospital with a modified Rankin score of 5.
Case 3: The patient presented in a comatose state with tetraplegia and serious facial and precordial injuries, following a motorcycle accident. CT revealed cerebral contusion, traumatic SAH and pneumocephalus with multiple facial, skull and skull base fractures including left sphenoid sinus wall. MRI performed on day 4 revealed cerebral infarction of the left frontotemporal lobe, and MRA revealed left ICA occlusion. He underwent conservative management and became independent with mild combined aphasia, 1 year after the accident. Sphenoid sinus wall fracture may indicate the BTCAO. The outcome of BTCAO appears to be largely dependent on the development of each collateral circulation.