Jp. Bleichner et al., POSTTRAUMATIC HEMIPLEGIA IN A PATIENT WIT H FIBROMUSCULAR DYSPLASIA OF THE CAROTID-ARTERY, Annales francaises d'anesthesie et de reanimation, 12(5), 1993, pp. 497-499
A 44-year-old patient, without remarkable medical history, was admitte
d with a head trauma with initial loss of consciousness and a thoracic
trauma. The initial treatment included the insertion of a chest drain
for evacuation of a pneumothorax and intrapleural analgesia with bupi
vacaine. The day after admission, the patient experienced a generalize
d epileptic crisis, without prodomes. Later, a left proportional hemip
legia with aphasia was recognized. The CT scan obtained immediately af
ter the crisis, as well as the carotid Doppler ultrasonography and ech
ocardiography were normal. The bilateral carotid angiography showed an
image of fibromuscular dysplasia of the extracranial segment of the r
ight internal carotid artery. The migration of a carotid thrombus init
iated by the trauma was hypothetized. A treatment with a platelet aggr
egation inhibiting drug was started and associated 20 days later with
low molecular weight heparin. The patient recovered a normal motility
within 10 days ; only the aphasia remained. Trauma of the carotid arte
ry is not a frequent cause of cerebrovascular accident. The occurrence
of the latter is favoured by a pre-existing lesion of this artery. Th
is case demonstrates that in a trauma patient not all central nervous
system manifestations are initiated by a head trauma.