[Post-traumatic hemiplegia in a patient with fibromuscular dysplasia of the carotid artery].
A 44-year-old patient, without remarkable medical history, was admitted 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 bupivacaine. The day after admission, the patient experienced a generalized epileptic crisis, without prodomes. Later, a left proportional hemiplegia with aphasia was recognized. The CT scan obtained immediately after the crisis, as well as the carotid Doppler ultrasonography and echocardiography were normal. The bilateral carotid angiography showed an image of fibromuscular dysplasia of the extracranial segment of the right internal carotid artery. The migration of a carotid thrombus initiated by the trauma was hypothetized. A treatment with a platelet aggregation 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 artery is not a frequent cause of cerebrovascular accident. The occurrence of the latter is favoured by a pre-existing lesion of this artery. This case demonstrates that in a trauma patient not all central nervous system manifestations are initiated by a head trauma.
Bleichner
J P
JP
Département d'Anesthésie-Réanimation, Hôpital Pontchaillou, Rennes.
Guillou
Y M
YM
Le Bouquin
V
V
Fleureaux
O
O
Mallédant
Y
Y
D000328:Adult; D001930:Brain Injuries / Q000150:complications*; D002340:Carotid Artery Diseases / Q000150:complications*; D005352:Fibromuscular Dysplasia / Q000150:complications*; D006429:Hemiplegia / Q000188:drug therapy / Q000209:etiology*; D006495:Heparin, Low-Molecular-Weight / Q000627:therapeutic use; D006801:Humans; D002542:Intracranial Embolism and Thrombosis / Q000209:etiology*; D008297:Male; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use
D006495:Heparin, Low-Molecular-Weight; D010975:Platelet Aggregation Inhibitors
Hémiplégie posttraumatique sur dysplasie fibromusculaire carotidienne.