The Teaching Point

This report is a reminder that carotid dissection is a rare but serious complication of high speed motor vehicle accidents. A high index of suspicion of carotid injury should be maintained in any traumatic injury as patients may be asymptomatic on admission. Morbidity from this injury can be significant. Ultrasound is a useful screening tool. However, CT angiogram or MRI angiogram are the gold standards. Sophisticated imaging may be required to plan optimal treatment which will need to be highly individualized.






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From the manuscript

Bilateral Carotid Artery Dissection after High Impact Road Traffic Accident

Free full text article: Bilateral Carotid Artery Dissection after High Impact Road Traffic Accident

Abstract
A 58 year old man was involved in a high impact road traffic incident and was admitted for observation. Asymptomatic for the first 24 hours, he collapsed with symptoms and signs consistent with a cerebrovascular accident. Computed tomography angiogram (CTA) and Magnetic resonance angiogram (MRA) demonstrated bilateral internal carotid artery dissections and a left middle cerebral artery infarct. It was not considered appropriate to attempt stenting or other revascularistation. The patient was treated with heparin prior to starting warfarin. He made a partial recovery and was discharged to a rehabilitation facility. This case is a reminder of carotid dissection as an uncommon but serious complication of high speed motor vehicle accident, which may be silent initially. Literature Review suggests risk stratification before relevant radiological screening at risk patients. Significant advances in CTA have made it the diagnostic tool of choice, but ultrasound is an important screening tool.






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