[Bilateral carotid dissection. A not to underestimate cause of neurological loss after road accident].
The dissection of the internal carotid artery is a rare complication of acceleration traumas of the upper spine. 30% of these dissections are caused by road accidents and again less than 30% of these occur bilateral as shown here. The symptoms are fronto-temporal and periorbital starting headaches spreading out to the occiput and Horner's syndrome. Complete hemiplegia as in our case is an impressive exception but the doctor in attendance should think of the carotid dissection. The exclusion of this complication is obligatory because treatment and outcome depend on it.The dynamic effects of bilateral carotid dissections may, as shown here, lead to relapsing cerebral infarctions with persisting neurologic deficits up to manifest hemiparesis. But restitution can be accomplished if early diagnosed by DSA and/or MRI. Therapy of choice is early prevention of persisting neurologic deficits using effective dosed heparin and depending on the residual lumen of the vessel oral anticoagulants or platelet antagonists for one year.
Stock
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Klinik für diagnostische Radiologie der Martin-Luther-Universität Halle-Wittenberg, Germany.
Peters
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Behrmann
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C
Spielmann
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RP
D000063:Accidents, Traffic; D000328:Adult; D015901:Angiography, Digital Subtraction; D000925:Anticoagulants / Q000627:therapeutic use; D001921:Brain / Q000000981:diagnostic imaging; D020215:Carotid Artery, Internal, Dissection / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D006429:Hemiplegia / Q000209:etiology; D006493:Heparin / Q000627:therapeutic use; D006801:Humans; D008279:Magnetic Resonance Imaging; D013997:Time Factors
D000925:Anticoagulants; D005343:Fibrinolytic Agents; D006493:Heparin