POSTTRAUMATIC HEMIPLEGIA IN A PATIENT WIT H FIBROMUSCULAR DYSPLASIA OF THE CAROTID-ARTERY

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.