[Postraumatic lesion of the carotid artery].
Postraumatic lesions of the carotid artery are very unusual in the general population and are especially rare in children due to the elasticity of their vessels. Because clinical expression of these lesions is mild, diagnosis can be delayed until the development of neurological signs, which are frequently irreversible. Neurological signs can be those of Horner's syndrome, drop attack, headache, vertigo, visual disorders, aphasia or transitory ischemic accidents. Carotid arterial lesion should be ruled out when the patient shows injuries in the soft tissue of the neck, when the neurological examination is incompatible with the findings of computed tomography (CT), when late neurological deficits develop or when the patient has Horner's syndrome. The patient reported herein presented partial motor seizures and hemiplegia 3 days after trauma. The most sensitive diagnostic test is angiography. Because this technique is aggressive, it is performed when suspicion is based on the results of Doppler sonography, CT or angiomagnetic resonance imaging. Treatment must be individualized. Standard therapy is anticoagulation but when this is contraindicated or the patient is asymptomatic anti-aggregating drugs are used. Thrombolytic treatment is reserved for the first few hours after injury. Surgical repair is the treatment of choice in patients with pseudoaneurysm. Because inaccessibility is one of the major difficulties in this type of surgery, intravascular stents can be a good therapeutic alternative in lesions unresponsive to medical treatment.
Balsera Garrido
B
B
Unidad de Cuidados Intensivos Pediátricos.Hospital Sant Joan de Déu. Unidad Integrada Hospital Clínic-Hospital Sant Joan de Déu. Universidad de Barcelona. Spain.
Rodríguez Ferrán
L
L
Pons Odena
M
M
Vernet Boril
A
A
Palomeque Rico
A
A
D000063:Accidents, Traffic; D000293:Adolescent; D020212:Carotid Artery Injuries / Q000175:diagnosis*; D002533:Cerebral Angiography; D006259:Craniocerebral Trauma / Q000175:diagnosis*; D015600:Glasgow Coma Scale; D006801:Humans; D008297:Male; D009104:Multiple Trauma; D019838:Neck Injuries / Q000175:diagnosis; D014057:Tomography, X-Ray Computed