Journal of Trauma and Injury

The Korean Society of Traumatology (대한외상학회)
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Delayed Diagnosis of Cerebral Infarction after Complete Occlusion of ICA due to Blunt Head Trauma: A Case of Report

두부둔상 후 내경동맥손상으로 인한 뇌경색의 지연진단: 증례보고

  • Yun, Jung-Ho (Department of Neurological Surgery, Dankook University Hospital, College of Medicine, University of Dankook) ;
  • Ko, Jung Ho (Department of Neurological Surgery, Dankook University Hospital, College of Medicine, University of Dankook) ;
  • Cho, Chun-Sung (Department of Neurological Surgery, Dankook University Hospital, College of Medicine, University of Dankook)
  • 윤정호 (단국대학교 의과대학 신경외과학교실) ;
  • 고정호 (단국대학교 의과대학 신경외과학교실) ;
  • 조준성 (단국대학교 의과대학 신경외과학교실)
  • Received : 2014.12.11
  • Accepted : 2015.10.04
  • Published : 2015.09.30
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Abstract

Blunt cerebrovascular injury is defined as a vertebral or carotid arterial structural wall injury resulting from nonpenetrating trauma. Complete traumatic internal carotid artery occlusion is very rare condition accounting for 0.08~0.4 0f all trauma patients and believed to be associated with the greatest risk of ischemic stroke reported in 50~90% in a few small series. A 55-year-male was admitted with drowsy mentality and severe headache after a fall down accident. Brain computed tomography showed a subdural hematoma at the both frontal area with a fracture of the occipital skull bone. Two days after admission, he suddenly complained with a right side hemiparesis of motor grade 2. Brain magnetic resonance diffusion demonstrated multiple high flow signal changes from the left frontal and parietal lesion. Computed tomographic angiogram (CTA) revealed absence of the left ICA flow. Trans femoral cerebral angiography (TFCA) showed complete occlusion of the left internal carotid artery (ICA) at ophthalmic segment in the left ICA angiogram and flows on the left whole hemispheric lesions through the anterior communicating artery in the right ICA angiogram. We decided to conduct close observations as a treatment for the patient because of acute subdural hematoma and sufficient contralateral cerebral flow by perfusion SPECT scan. Two weeks after the accident, he was treated with heparin anticoagulation within INR 2~4 ranges. He recovered as the motor grade 4 without another neurologic deficit after 3 months.

Keywords

References

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