TRAUMATIC INJURY OF INTERNAL CAROTID-ARTE RY - REPORT ON A CASE WITH SEVERE SEQUELAE

Blunt traumatic injury to the extracranial internal carotid artery may lead to a dissection with resultant stenosis, occlusion, or a dissect ing aneurysm. Delayed clinical presentation weeks, months, and even ye ars after the injury is rare, but has important diagnostic, therapeuti c and forensic implications. In the current era, where computed tomogr aphy is replacing angiography as the main diagnostic procedure, it is extremely important to keep this diagnosis in mind. We report the case of a 31-years-old male patient, who did well after a motorcycle accid ent with head and neck injury for six years. Since then he only showed left-side Horner's syndrome, which unfortunately was ignored. In 1993 the patient developed occlusion of central retinal artery, and after a therapy with streptokinase he presented With right-side palsy and co mplete aphasia. CT-scan revealed a large edematous infarction in the m iddle cerebral artery territory. Transfemoral digital substraction ang iography however demonstrated a dissecting aneurysm of the left extrac ranial internal carotid artery as the source of intracranial embolizat ion. Severe sequelae of this kind can only be warded of by early diagn osis and proper surgical therapy of vascular injury. Therefore even mi nimal symptoms suggesting the possibility of a traumatic injury to the carotid artery are recommending timely angiographic investigation.