TRAUMATIC CAROTID-ARTERY DISSECTION

Traumatic carotid artery dissection is rarely seen as a cause of death in the forensic setting. Three cases of traumatic carotid artery diss ection that demonstrate many of the typical features are presented. Th ere is usually a history of some violent trauma to the head or neck, m otor vehicle accidents being the commonest cause. The carotid artery m ay be injured anywhere from the common carotid portion to the cavernou s sinus, resulting in infarction of the corresponding cerebral hemisph ere. Clinically, symptoms may include loss of consciousness, hemipares is, aphasia, and Horner's syndrome, these typically occurring after an interval of hours to days. Carotid artery injury may not be associate d with evidence of external injury and initially may go undetected or may be misinterpreted in the setting of associated neck or head trauma . The commonest mechanisms are thought to be blunt neck trauma and nec k hyperextension. The cases presented highlight the importance of earl y diagnosis if surgery is to be possible to avoid a fatal outcome.