Original communication| Volume 75, ISSUE 4, P543-549, April 1974

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Delayed presentation of carotid intimal tear following blunt craniocervical trauma

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      Blunt craniocervical trauma may produce carotid artery stenosis and occlusion with delayed and unusual clinical manifestations. This condition is illustrated by two patients with traumatic intimal tears, presenting with transient neurologic deficit or asymptomatic bruits several months or years after injury. Such injuries usually follow cranial trauma which stretches the carotid artery by sudden extension and counter-rotation of the head or by direct blunt trauma to the carotid bifurcation. The hallmark of such blunt carotid artery injury is the delayed onset of symptoms, which usually result from an intimal flap and subsequent embolic phenomena. While the symptoms are generally those of carotid insufficiency, a diagnosis of cervical carotid trauma is seldom made clinically because the entity is easily confused with intracranial injury. Aggressive angiographic evaluation and recent improvements in the safety of carotid artery surgery should improve the otherwise poor prognosis for those patients correctly diagnosed in whom operation is properly timed and performed.
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        • Calcaterra T.C.
        • Holt G.P.
        Carotid artery injury.
        Laryngoscope. 1972; 82: 321
        • DeWeese J.A.
        • Rob C.G.
        • Satran R.
        • Morris F.H.
        • Lipchik E.O.
        • Zehl D.N.
        • Long J.M.
        Surgical treatment for occlusive disease of the carotid artery.
        Ann. Surg. 1968; 168: 85
        • Fleming J.F.R.
        • Petric D.
        Traumatic thrombosis of the internal carotid artery with delayed hemiplegia.
        Can. J. Surg. 1968; 11: 166
        • Gurdjian E.S.
        • Hardy W.G.
        • Thomas L.M.
        Closed cervical cranial trauma associated with involvement of carotid and vertebral arteries.
        J. Neurosurg. 1963; 20: 418
        • Gurdjian E.S.
        • Blaise A.
        • Renato W.S.
        • Thomas L.M.
        Spasm of the extracranial internal carotid artery resulting from blunt trauma demonstrated by angiography.
        J. Neurosurg. 1971; 35: 742
        • Hare R.R.
        • Gaspar M.R.
        The intimal flap.
        Arch. Surg. 1971; 102: 552
        • Horner T.G.
        • Maroon J.C.
        • Campbell R.L.
        Traumatic occlusion of the internal carotid secondary to closed craniocervical injury.
        J. Indiana Med. Assoc. 1970; 63: 136
        • Hughes J.T.
        • Brownell B.
        Traumatic thrombosis of the internal carotid artery in the neck.
        J. Neurol. Neurosurg. Psychat. 1968; 31: 307
        • Javid H.
        • Ostermiller W.E.
        • Heughesh J.W.
        • Dye W.S.
        • Hunter J.A.
        • Najafi H.
        • Julian C.
        Carotid endarterectomy for asymptomatic patients.
        Arch. Surg. 1971; 102: 389
        • Jernigan W.R.
        • Gardner W.C.
        Carotid artery injuries due to closed cervical trauma.
        J. Trauma. 1971; 11: 429
        • Little J.M.
        • May J.
        Civilian arterial injuries.
        Med. J. Aust. 1972; 1: 841
        • Little J.M.
        • May J.
        • Vanderfield G.K.
        • Lamond S.
        Traumatic thrombosis of the internal carotid artery.
        Lancet. 1969; 2: 926
        • McGough E.C.
        • Helfrich L.R.
        • Hughes R.K.
        Traumatic intimal prolapse of the common carotid artery.
        Am. J. Surg. 1972; 123: 724
        • Pitner S.E.
        Carotid thrombosis due to intraoral trauma.
        New Engl. J. Med. 1966; 274: 764
        • Thompson J.E.
        • Austin D.J.
        • Patman R.D.
        Carotid endarterectomy for cerebrovascular insufficiency.
        Ann. Srug. 1970; 172: 663
        • Thompson J.E.
        • Kartchner M.M.
        • Austin D.J.
        • Wheeler C.G.
        • Patman R.D.
        Carotid endarterectomy for cerebrovascular insufficiency (stroke): follow-up of 359 cases.
        Ann. Surg. 1966; 163: 751
        • Towne J.B.
        • Neis D.D.
        • Smith J.W.
        Thrombosis of the internal carotid artery following blunt cervical trauma.
        Arch. Surg. 1972; 104: 565
        • Verneil M.
        Contusions multiples, délire violent, hémiplégic à droit, signes de compressoin cérébrale.
        Bull. Acad. Nat. Med. (Paris). 1872; 36: 46
        • Yamada S.
        • Kindt G.W.
        • Youmans J.R.
        Carotid artery occlusion due to nonpenetrating injury.
        J. Trauma. 1967; 7: 333
        • Yashon D.
        • Johnson II, A.B.
        • Jane J.A.
        Bilateral internal carotid artery occlusion secondary to closed head injuries.
        J. Neurol. Neurosurg. Psychiat. 1964; 27: 547
        • Zilkha A.
        Traumatic occlusion of the internal carotid artery.
        Radiology. 1970; 97: 543