Traumatic dissections of the extracranial internal carotid artery

Bahram MokriDepartments of Neurology, Neurologic Surgery, and Diagnostic Radiology, Mayo Clinic and Mayo Foundation, Rochester, Minnesota

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David G. PiepgrasDepartments of Neurology, Neurologic Surgery, and Diagnostic Radiology, Mayo Clinic and Mayo Foundation, Rochester, Minnesota

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O. Wayne HouserDepartments of Neurology, Neurologic Surgery, and Diagnostic Radiology, Mayo Clinic and Mayo Foundation, Rochester, Minnesota

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✓ Traumatic dissections of the extracranial internal carotid artery (ICA) in 18 patients aged 19 to 55 years were studied. All had suffered blunt head or neck injury of marked or moderate severity; motor-vehicle accidents were the leading cause of the injury. Delayed focal cerebral ischemic symptoms were the most common presenting symptoms. Less commonly noted was focal unilateral headache associated with oculosympathetic paresis or bruit. Following a head injury, the abrupt onset of focal cerebral symptoms after a lucid interval should raise the suspicion of arterial injury, particularly when computerized tomography fails to show abnormalities that would explain the evolving neurological deficits on the basis of direct trauma to the brain. Unilateral headaches, oculosympathetic palsy, and bruits also help in establishing the diagnosis. Focal cerebral ischemic symptoms may develop months or years after the initial trauma. These delayed symptoms are caused by embolization from a thrombus within a residual dissecting aneurysm. Common angiographic findings, in decreasing order of frequency, are: aneurysm, stenosis of the lumen, occlusion, intimal flap, distal branch occlusion (embolization), and slow ICA-to-middle cerebral artery flow. Although two patients died as the result of massive cerebral infarction and edema and some were left with severe neurological deficits, most made a good recovery. Residual dissecting aneurysms and occlusion seem to occur more frequently with traumatic dissections than with spontaneous dissections of the extracranial ICA.

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  • 1.

    Ajir F, & Tibbetts JC: Post-traumatic occlusion of the supraclinoid internal carotid artery. Neurosurgery 9:173176, 1981 Ajir F, Tibbetts JC: Post-traumatic occlusion of the supraclinoid internal carotid artery. Neurosurgery 9:173–176, 1981

    • Search Google Scholar
    • Export Citation
  • 2.

    Alpert JN, , Gerson LP, & Hall RJ, et al: Reversible angiopathy. Stroke 13:100105, 1982 Alpert JN, Gerson LP, Hall RJ, et al: Reversible angiopathy. Stroke 13:100–105, 1982

    • Search Google Scholar
    • Export Citation
  • 3.

    Anderson WAD, & Scotti TM: Synopsis of Pathology, ed 10. St Louis: CB Mosby, 1980, pp 290293 Anderson WAD, Scotti TM: Synopsis of Pathology, ed 10. St Louis: CB Mosby, 1980, pp 290–293

    • Search Google Scholar
    • Export Citation
  • 4.

    Batzdorf U, , Bentson JR, & Machleder HI: Blunt trauma to the high cervical carotid artery. Neurosurgery 5:195201, 1979 Batzdorf U, Bentson JR, Machleder HI: Blunt trauma to the high cervical carotid artery. Neurosurgery 5:195–201, 1979

    • Search Google Scholar
    • Export Citation
  • 5.

    Beatty RA: Dissecting hematoma of the internal carotid artery following chiropractic cervical manipulation. J Trauma 17:248249, 1977 Beatty RA: Dissecting hematoma of the internal carotid artery following chiropractic cervical manipulation. J Trauma 17:248–249, 1977

    • Search Google Scholar
    • Export Citation
  • 6.

    Bickerstaff ER: Aetiology of acute hemiplegia in childhood. Br Med J 2:8287, 1964 Bickerstaff ER: Aetiology of acute hemiplegia in childhood. Br Med J 2:82–87, 1964

    • Search Google Scholar
    • Export Citation
  • 7.

    Bradac GB, , Kaernbach A, & Bolk-Weischedel D, et al: Spontaneous dissecting aneurysm of cervical cerebral arteries. Report of six cases and review of the literature. Neuroradiology 21:149154, 1981 Bradac GB, Kaernbach A, Bolk-Weischedel D, et al: Spontaneous dissecting aneurysm of cervical cerebral arteries. Report of six cases and review of the literature. Neuroradiology 21:149–154, 1981

    • Search Google Scholar
    • Export Citation
  • 8.

    Cairns H: Vascular aspects of head injuries. Lisboa Med 19:375410, 1942 Cairns H: Vascular aspects of head injuries. Lisboa Med 19:375–410, 1942

    • Search Google Scholar
    • Export Citation
  • 9.

    Chandler WF: Carotid Artery Injuries. Mt Kisco, NY: Futura, 1982 Chandler WF: Carotid Artery Injuries. Mt Kisco, NY: Futura, 1982 10. Ibid., pp 33–48

    • Search Google Scholar
    • Export Citation
  • 10.

    Ibid., pp 3348 Ibid., pp 33–48

  • 11.

    Davis JM, & Zimmerman RA: Injury of the carotid and vertebral arteries. Neuroradiology 25:5569, 1983 Davis JM, Zimmerman RA: Injury of the carotid and vertebral arteries. Neuroradiology 25:55–69, 1983

    • Search Google Scholar
    • Export Citation
  • 12.

    Dragon R, , Saranchak H, & Lakin P, et al: Blunt injuries to the carotid and vertebral arteries. Am J Surg 141:497500, 1981 Dragon R, Saranchak H, Lakin P, et al: Blunt injuries to the carotid and vertebral arteries. Am J Surg 141:497–500, 1981

    • Search Google Scholar
    • Export Citation
  • 13.

    Ehrenfeld WK, & Wylie EJ: Spontaneous dissection of the internal carotid artery. Arch Surg 111:12941301, 1976 Ehrenfeld WK, Wylie EJ: Spontaneous dissection of the internal carotid artery. Arch Surg 111:1294–1301, 1976

    • Search Google Scholar
    • Export Citation
  • 14.

    Fisher CM: The headache and pain of spontaneous carotid dissection. Headache 22:6065, 1982 Fisher CM: The headache and pain of spontaneous carotid dissection. Headache 22:60–65, 1982

    • Search Google Scholar
    • Export Citation
  • 15.

    Fisher CM, , Ojemann RG, & Roberson GH: Spontaneous dissection of cervico-cerebral arteries. Can J Neurol Sci 5:919, 1978 Fisher CM, Ojemann RG, Roberson GH: Spontaneous dissection of cervico-cerebral arteries. Can J Neurol Sci 5:9–19, 1978

    • Search Google Scholar
    • Export Citation
  • 16.

    Fleming JFR, & Petrie D: Traumatic thrombosis of the internal carotid artery with delayed hemiplegia. Can J Surg 11:166172, 1968 Fleming JFR, Petrie D: Traumatic thrombosis of the internal carotid artery with delayed hemiplegia. Can J Surg 11:166–172, 1968

    • Search Google Scholar
    • Export Citation
  • 17.

    French BN, , Cobb CA III, & Dublin AB: Cranial computed tomography in the diagnosis of symptomatic indirect trauma to the carotid artery. Surg Neurol 15:256267, 1981 French BN, Cobb CA III, Dublin AB: Cranial computed tomography in the diagnosis of symptomatic indirect trauma to the carotid artery. Surg Neurol 15:256–267, 1981

    • Search Google Scholar
    • Export Citation
  • 18.

    Friedman WA, , Day AL, & Quisling RG, et al: Cervical carotid dissecting aneurysms. Neurosurgery 7:207214, 1980 Friedman WA, Day AL, Quisling RG, et al: Cervical carotid dissecting aneurysms. Neurosurgery 7:207–214, 1980

    • Search Google Scholar
    • Export Citation
  • 19.

    Fry RE, & Fry WJ: Extracranial carotid artery injuries. Surgery 88:581587, 1980 Fry RE, Fry WJ: Extracranial carotid artery injuries. Surgery 88:581–587, 1980

    • Search Google Scholar
    • Export Citation
  • 20.

    Gee W, , Kaupp HA, & McDonald KM, et al: Spontaneous dissection of internal carotid arteries. Spontaneous resolution documented by serial ocular pneumoplethysmography and angiography. Arch Surg 115:944949, 1980 Gee W, Kaupp HA, McDonald KM, et al: Spontaneous dissection of internal carotid arteries. Spontaneous resolution documented by serial ocular pneumoplethysmography and angiography. Arch Surg 115:944–949, 1980

    • Search Google Scholar
    • Export Citation
  • 21.

    Hart RG, & Easton JD: Dissections of cervical and cerebral arteries. Neurol Clin 1:155182, 1983 Hart RG, Easton JD: Dissections of cervical and cerebral arteries. Neurol Clin 1:155–182, 1983

    • Search Google Scholar
    • Export Citation
  • 22.

    Hodge CJ Jr, & Lee SH: Spontaneous dissecting cervical carotid artery aneurysm. Neurosurgery 10:9395, 1982 Hodge CJ Jr, Lee SH: Spontaneous dissecting cervical carotid artery aneurysm. Neurosurgery 10:93–95, 1982

    • Search Google Scholar
    • Export Citation
  • 23.

    Houser OW, , Mokri B, & Sundt TM Jr, et al: Spontaneous cervical cephalic arterial dissection and its residuum: angiographic spectrum. AJNR 5:2734, 1984 Houser OW, Mokri B, Sundt TM Jr, et al: Spontaneous cervical cephalic arterial dissection and its residuum: angiographic spectrum. AJNR 5:27–34, 1984

    • Search Google Scholar
    • Export Citation
  • 24.

    Huckman MS, , Shenk GI, & Neems RL, et al: Transfemoral cerebral arteriography versus direct percutaneous carotid and brachial arteriography: a comparison of complication rates. Radiology 132:9397, 1979 Huckman MS, Shenk GI, Neems RL, et al: Transfemoral cerebral arteriography versus direct percutaneous carotid and brachial arteriography: a comparison of complication rates. Radiology 132:93–97, 1979

    • Search Google Scholar
    • Export Citation
  • 25.

    Kapp JP, & Smith RR: Spontaneous resolution of occlusive lesions of the carotid artery. J Neurosurg 56:7379, 1982 Kapp JP, Smith RR: Spontaneous resolution of occlusive lesions of the carotid artery. J Neurosurg 56:73–79, 1982

    • Search Google Scholar
    • Export Citation
  • 26.

    Krajewski LP, & Hertzer NR: Blunt carotid artery trauma. Report of two cases and review of the literature. Ann Surg 191:341346, 1980 Krajewski LP, Hertzer NR: Blunt carotid artery trauma. Report of two cases and review of the literature. Ann Surg 191:341–346, 1980

    • Search Google Scholar
    • Export Citation
  • 27.

    Lai MD, , Hoffman HB, & Adamkiewicz JJ: Dissecting aneurysm of internal carotid artery after non-penetrating neck injury. Case report. Acta Radiol [Diagn] 5:290295, 1966 Lai MD, Hoffman HB, Adamkiewicz JJ: Dissecting aneurysm of internal carotid artery after non-penetrating neck injury. Case report. Acta Radiol [Diagn] 5:290–295, 1966

    • Search Google Scholar
    • Export Citation
  • 28.

    Liliequist B: The roentgenologic appearance of spontaneous dissecting aneurysm of the cervical internal carotid artery. Report of a case. Vasc Surg 2:223226, 1968 Liliequist B: The roentgenologic appearance of spontaneous dissecting aneurysm of the cervical internal carotid artery. Report of a case. Vasc Surg 2:223–226, 1968

    • Search Google Scholar
    • Export Citation
  • 29.

    Lloyd J, & Bahnson HT: Bilateral dissecting aneurysms of the internal carotid arteries. Am J Surg 122:549551, 1971 Lloyd J, Bahnson HT: Bilateral dissecting aneurysms of the internal carotid arteries. Am J Surg 122:549–551, 1971

    • Search Google Scholar
    • Export Citation
  • 30.

    Luken MG III, , Ascherl GF Jr, & Correll JW, et al: Spontaneous dissecting aneurysms of the extracranial internal carotid artery. Clin Neurosurg 26:353375, 1979 Luken MG III, Ascherl GF Jr, Correll JW, et al: Spontaneous dissecting aneurysms of the extracranial internal carotid artery. Clin Neurosurg 26:353–375, 1979

    • Search Google Scholar
    • Export Citation
  • 31.

    McNeill DH Jr, , Dreisbach J, & Marsden RJ: Spontaneous dissection of the internal carotid artery. Its conservative management with heparin sodium. Arch Neurol 37:5455, 1980 McNeill DH Jr, Dreisbach J, Marsden RJ: Spontaneous dissection of the internal carotid artery. Its conservative management with heparin sodium. Arch Neurol 37:54–55, 1980

    • Search Google Scholar
    • Export Citation
  • 32.

    Mokri B, , Houser OW, & Sundt TM Jr: Idiopathic regressing arteriopathy. Ann Neurol 2:466472, 1977 Mokri B, Houser OW, Sundt TM Jr: Idiopathic regressing arteriopathy. Ann Neurol 2:466–472, 1977

    • Search Google Scholar
    • Export Citation
  • 33.

    Mokri B, , Piepgras DG, & Sundt TM Jr, et al: Extracranial internal carotid artery aneurysms. Mayo Clin Proc 57:310321, 1982 Mokri B, Piepgras DG, Sundt TM Jr, et al: Extracranial internal carotid artery aneurysms. Mayo Clin Proc 57:310–321, 1982

    • Search Google Scholar
    • Export Citation
  • 34.

    Mokri B, , Sundt TM Jr, & Houser OW: Spontaneous internal carotid dissection, hemicrania, and Horner's syndrome. Arch Neurol 36:677680, 1979 Mokri B, Sundt TM Jr, Houser OW: Spontaneous internal carotid dissection, hemicrania, and Horner's syndrome. Arch Neurol 36:677–680, 1979

    • Search Google Scholar
    • Export Citation
  • 35.

    Mokri B, , Sundt TM Jr, & Houser OW, et al: Spontaneous dissection of the cervical internal carotid artery. Ann Neurol 19:126138, 1986 Mokri B, Sundt TM Jr, Houser OW, et al: Spontaneous dissection of the cervical internal carotid artery. Ann Neurol 19:126–138, 1986

    • Search Google Scholar
    • Export Citation
  • 36.

    New PFJ, & Momose KJ: Traumatic dissection of the internal carotid artery at the atlantoaxial level, secondary to nonpenetrating injury. Radiology 93:4149, 1969 New PFJ, Momose KJ: Traumatic dissection of the internal carotid artery at the atlantoaxial level, secondary to nonpenetrating injury. Radiology 93:41–49, 1969

    • Search Google Scholar
    • Export Citation
  • 37.

    Ojemann RG, , Fisher CM, & Rich JC: Spontaneous dissecting aneurysm of the internal carotid artery. Stroke 3:434440, 1972 Ojemann RG, Fisher CM, Rich JC: Spontaneous dissecting aneurysm of the internal carotid artery. Stroke 3:434–440, 1972

    • Search Google Scholar
    • Export Citation
  • 38.

    Pitner SE: Carotid thrombosis due to intraoral trauma. An unusual complication of a common childhood accident. N Engl J Med 274:764767, 1966 Pitner SE: Carotid thrombosis due to intraoral trauma. An unusual complication of a common childhood accident. N Engl J Med 274:764–767, 1966

    • Search Google Scholar
    • Export Citation
  • 39.

    Ringel SP, , Harrison SH, & Norenberg MD, et al: Fibromuscular dysplasia: multiple “spontaneous” dissecting aneurysms of the major cervical arteries. Ann Neurol 1:301304, 1977 Ringel SP, Harrison SH, Norenberg MD, et al: Fibromuscular dysplasia: multiple “spontaneous” dissecting aneurysms of the major cervical arteries. Ann Neurol 1:301–304, 1977

    • Search Google Scholar
    • Export Citation
  • 40.

    Rubio PA, , Reul GJ Jr, & Beall AC Jr, et al: Acute carotid artery injury: 25 years' experience, J Trauma 14:967973, 1974 Rubio PA, Reul GJ Jr, Beall AC Jr, et al: Acute carotid artery injury: 25 years' experience, J Trauma 14:967–973, 1974

    • Search Google Scholar
    • Export Citation
  • 41.

    Scherman BM, & Tucker WS: Bilateral traumatic thrombosis of the internal carotid arteries in the neck: a case report with review of the literature. Neurosurgery 10:751753, 1982 Scherman BM, Tucker WS: Bilateral traumatic thrombosis of the internal carotid arteries in the neck: a case report with review of the literature. Neurosurgery 10:751–753, 1982

    • Search Google Scholar
    • Export Citation
  • 42.

    Stringer WL, & Kelly DL Jr: Traumatic dissection of the extracranial internal carotid artery. Neurosurgery 6:123130, 1980 Stringer WL, Kelly DL Jr: Traumatic dissection of the extracranial internal carotid artery. Neurosurgery 6:123–130, 1980

    • Search Google Scholar
    • Export Citation
  • 43.

    Sundt TM Jr Jr, , Pearson BW, & Piepgras DG, et al: Surgical management of aneurysms of the distal extracranial internal carotid artery. J Neurosurg 64:169182, 1986 Sundt TM Jr, Pearson BW, Piepgras DG, et al: Surgical management of aneurysms of the distal extracranial internal carotid artery. J Neurosurg 64:169–182, 1986

    • Search Google Scholar
    • Export Citation
  • 44.

    Tangchai P, & Pisitbutr M: Angiographic dissecting aneurysm of internal carotid artery. An autopsy case report. J Med Assoc Thai 54:598601, 1971 Tangchai P, Pisitbutr M: Angiographic dissecting aneurysm of internal carotid artery. An autopsy case report. J Med Assoc Thai 54:598–601, 1971

    • Search Google Scholar
    • Export Citation
  • 45.

    Verneuil M: Contusions multiples, délire violent, hémi-plégie à droite, signes de compression cérébrale. Bull Acad Natl Med (Paris) 1:4656, 1872 Verneuil M: Contusions multiples, délire violent, hémi-plégie à droite, signes de compression cérébrale. Bull Acad Natl Med (Paris) 1:46–56, 1872

    • Search Google Scholar
    • Export Citation
  • 46.

    Vitek JJ: Femoro-cerebral angiography: analysis of 2,000 consecutive examinations, special emphasis on carotid arteries catheterization in older patients. AJR 118:633647, 1973 Vitek JJ: Femoro-cerebral angiography: analysis of 2,000 consecutive examinations, special emphasis on carotid arteries catheterization in older patients. AJR 118:633–647, 1973

    • Search Google Scholar
    • Export Citation
  • 47.

    West TET, , Davies RJ, & Kelly RE: Horner's syndrome and headache due to carotid artery disease. Br Med J 1:818820, 1976 West TET, Davies RJ, Kelly RE: Horner's syndrome and headache due to carotid artery disease. Br Med J 1:818–820, 1976

    • Search Google Scholar
    • Export Citation
  • 48.

    Yamada S, , Kindt GW, & Youmans JR: Carotid artery occlusion due to nonpenetrating injury. J Trauma 7:333342, 1967 Yamada S, Kindt GW, Youmans JR: Carotid artery occlusion due to nonpenetrating injury. J Trauma 7:333–342, 1967

    • Search Google Scholar
    • Export Citation
  • 49.

    Young PH, , Smith KR Jr, & Crafts DC, et al: Traumatic occlusion in fibromuscular dysplasia of the carotid artery. Surg Neurol 16:432437, 1981 Young PH, Smith KR Jr, Crafts DC, et al: Traumatic occlusion in fibromuscular dysplasia of the carotid artery. Surg Neurol 16:432–437, 1981

    • Search Google Scholar
    • Export Citation
  • 50.

    Zelenock GB, , Kazmers A, & Whitehouse WM Jr, et al: Extracranial internal carotid artery dissections. Noniatrogenic traumatic lesions. Arch Surg 117:425432, 1982 Zelenock GB, Kazmers A, Whitehouse WM Jr, et al: Extracranial internal carotid artery dissections. Noniatrogenic traumatic lesions. Arch Surg 117:425–432, 1982

    • Search Google Scholar
    • Export Citation

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