The Case Files: Traumatic Carotid Dissection

By Hsiao, Jonie MD   A 30-year-old man who was right-hand dominant presented 10 days after sustaining left-sided face and head trauma from a fall from a skateboard at an unknown speed. He lost consciousness for several seconds, and initially developed a headache with nausea and vomiting. A non-contrast head CT performed at another hospital done two days after the incident was reportedly negative.   He now presents primarily with concerns about the appearance of his left eye. He has notable anisocoria and a droopy eyelid. His left pupil is notably smaller, 2 mm, compared with the right eye, 5 mm. Both are reactive. The rest of his neurological exam was within normal limits including visual acuity, but he had slightly decreased taste in the anterior two-thirds of his tongue (CN VII deficit). There was no audible carotid bruit.   An MRI/MRA revealed a left internal carotid dissection at the level of the bifurcation as well as a small punctate area of infarct in the left globus pallidus. A diagnosis of Horner syndrome secondary to carotid dissection was made, and the patient was admitted and started on anticoagulation. His course was complicated four months later by the detection of an aneurysm at the site of injury, although he developed no further deficits and did not require surgical intervention. Traumatic carotid dissection is an uncommonly diagnosed condition, even in the emergent setting. The rate of carotid or vertebral dissection is reported to be one in 1,000 in pati...
Source: The Case Files - Category: Emergency Medicine Tags: Blog Posts Source Type: research