Deconstructing Dissections: A Case Report and Review of Blunt Cerebrovascular Injury of the Neck
| Autor: | Jessica S. Whittle, W. Douglas Gregorie, Brittany A. Walsh |
|---|---|
| Jazyk: | angličtina |
| Rok vydání: | 2018 |
| Předmět: |
medicine.medical_specialty
business.industry medicine.medical_treatment Incidence (epidemiology) Vertebral artery dissection Gold standard lcsh:Medical emergencies. Critical care. Intensive care. First aid 030208 emergency & critical care medicine Case Report General Medicine lcsh:RC86-88.9 medicine.disease Surgery Diagnostic modalities 03 medical and health sciences 0302 clinical medicine Blunt Hemiparesis Medicine Intubation medicine.symptom business Motor vehicle crash |
| Zdroj: | Case Reports in Emergency Medicine Case Reports in Emergency Medicine, Vol 2018 (2018) |
| ISSN: | 2090-6498 2090-648X |
| Popis: | Blunt cerebrovascular injury (BCVI) is a term encompassing traumatic carotid and vertebral artery dissection or disruption. While the reported incidence appears to be increasing as diagnostic modalities improve, these injuries are often diagnosed only after patients have developed acute neurologic symptoms. These injuries often result in severe permanent neurologic disability or death. The gold standard for diagnosis has historically been a 4-vessel arteriogram. However, newer data are suggesting that computed tomographic angiography may be more appropriate for most patients and new criteria for its utilization have been developed. We report a case of bilateral carotid dissection in a 23-year-old woman involved in a motor vehicle collision (MVC). She initially presents with a normal neurologic exam and two hours later develops hemiparesis. She is treated with antiplatelet therapy and given intravascular catheter directed tissue plasminogen activator with carotid stent placement. Nonetheless, the patient goes on to require intubation and, ultimately, a tracheostomy and transfer to an inpatient rehabilitation setting due to continued hemiparesis. This case highlights the need for increased awareness of a potentially debilitating, life-threatening disease process. A high index of suspicion is required among emergency medicine physicians for early diagnosis and treatment of trauma patients with BCVI. |
| Databáze: | OpenAIRE |
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