DOI: 10.36347/sjams.2018.v06i03.045

Pages: 1042-1044

As a results of high energy traumas on head and neck, blunt carotid artey dissection (CAD) may occur. The incidence of CAD among all patients with blunt trauma is estimated to be 0.08–1.2%. Motor vehicle accidents are the cause of carotid dissections at rates varying between 53% and 82%. CAD may lead to ischemic stroke and subsequent disability or death. Case fatality has been reported in up to 31% of the patients with CAD, and severe disability in up to 56% of the survivors. To prevent these serious complications, early recognition of this injury is important. In the present case, the patient with general trauma after motor vehicle accident was brought to emergency service with open consciousness. Glascow Coma Score was 13 and no pathology was seen in brain and cervical tomography images. Due to blunt abdominal injury, owing to sudden fall in hemoglobin values, the patient underwent emergency operation by general surgery team. In postoperative period, he was transferred to anesthesia intensive care unit. Anisocoria in pupillae was seen on 3rd day of admission. Diffusion MR investigation was carried out. Widespread diffusion restriction suggested carotid lesion. Cerebellar tonsillar herniation was present. In repeat cerebral angiography, contrast filling was not observed in both internal carotid arteries. The patient died on the 24th day of admission. In patients admitted to emergency service after motor vehicle accidents, artery dissection should always be kept in mind. What is challenging in such cases is to diagnose CAD before the onset of neurological symptoms. Latent interval between the injury and emergence of symptoms may be misleading. It should be borne in mind that, particularly in patient followed under sedation, diagnosis may bemused easily as neurological symptoms can not be observed clearly.