Blunt Cerebrovascular Injury: A Visual Case Report with Computed Tomography Angiography Findings Revealing Carotid and Vertebral Artery Dissection
Correspondence should be addressed to Edmund Hsu, MD at edhsu@hs.uci.edu
DOI: https://doi.org/10.5070/M5.52229
ABSTRACT:
Blunt cerebrovascular injury (BCVI) is defined as blunt traumatic injury to the carotid or vertebral vessels. Although rare, understanding risk factors and management of possible complications is vital in the emergency department (ED) setting since BCVI is associated with ischemic stroke and potential for poor neurologic outcome or death. In this case, a 27-year-old female patient presented with headache following a motor vehicle collision. Computed tomography angiography (CTA) of the neck revealed a right internal carotid artery dissection. Despite the injury, the patient was largely asymptomatic besides headache and discharged on acetylsalicylic acid (ASA) 81 mg to prevent stroke. Follow-up CTA one week later revealed worsening of the carotid dissection and a new vertebral artery dissection. The patient was admitted and received a diagnostic cerebral angiogram that elucidated the extent of her vascular injuries. The patient was discharged on ASA 325 mg and was followed for 27 months with no further neurological symptoms. Blunt cerebrovascular injury is a potentially life-threatening, yet often underrecognized, injury that occurs in the carotid or vertebral arteries. It is most often associated with high-energy trauma. Up to 80% of patients with BCVI are initially asymptomatic, and effective screening is important for timely diagnosis. Computed tomography angiography is the preferred choice for initial screening and diagnosis of BCVI. Treatment may involve surgical repair, endovascular intervention, and antithrombotic therapy.
Topics: Blunt cerebrovascular injury (BCVI), carotid artery dissection, vertebral artery dissection, computed tomography angiography (CTA), case report.
