title: Traumatic Dissection of Four Brain-Supplying Arteries without Neurologic Deficit.
abstract: Study Design Case report and review of the literature. Objectives Case report of a traumatic dissection of all major brain-supplying arteries resulting from a horseback-riding accident. Overview of the literature on diagnostic and therapeutic recommendations. Methods Case presentation. For the discussion, handpicked articles and PubMed database research with the keywords "dissection," "vertebral artery," "spine trauma," "computed tomography," "magnetic resonance imaging," and "angiography" were used. Results Despite high-energy induced acute lesion of all four cervical arteries, this 45-year-old patient did not demonstrate signs of microemboli nor suffer from stroke. Conclusion In case of high-energy trauma of the head and/or the neck, emergency physicians must consider traumatic cervical artery dissection (TCAD). Thus, emergency care algorithms should routinely include computed tomography angiography and magnetic resonance imaging. Although the incidence of TCAD-induced stroke is low, antiplatelet therapy is recommended in the presence of TCAD.
authors.affiliation: Department of Special Orthopaedic, Trauma and Reconstructive Surgery, Charité-University Medicine Berlin, Berlin, Germany.
authors.forename: Florian
authors.initials: F
authors.lastname: Pröscholdt
authors.affiliation: Department of Special Orthopaedic, Trauma and Reconstructive Surgery, Charité-University Medicine Berlin, Berlin, Germany.
authors.forename: Sandro
authors.initials: S
authors.lastname: Heining
authors.affiliation: Department of Radiology, Charité-University Medicine Berlin, Berlin, Germany.
authors.forename: Maciej
authors.initials: M
authors.lastname: Powerski
authors.affiliation: Department of Neurology, Center for Stroke Research, Charité-University Medicine Berlin, Berlin, Germany.
authors.forename: Christian H
authors.initials: CH
authors.lastname: Nolte
authors.affiliation: Department of Special Orthopaedic, Trauma and Reconstructive Surgery, Charité-University Medicine Berlin, Berlin, Germany.
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Ertel
keywords: angiography; anticoagulation; arterial dissection; computed tomography; magnetic resonance imaging; spine trauma
references.citation: J Vasc Surg. 2010 Oct;52(4):1052-7
references.pmid: 20888534
references.citation: Ann Surg. 2000 May;231(5):672-81
references.pmid: 10767788
references.citation: Ann Surg. 1996 May;223(5):513-22; discussion 522-5
references.pmid: 8651742
references.citation: Am Surg. 2000 Nov;66(11):1023-7
references.pmid: 11090011
references.citation: Surg Neurol. 2006 Mar;65(3):238-45; discussion 245-6
references.pmid: 16488240
references.citation: Arch Surg. 2009 Jul;144(7):685-90
references.pmid: 19620551
references.citation: Ann Surg. 2002 Sep;236(3):386-93; discussion 393-5
references.pmid: 12192325
references.citation: J Trauma. 2009 Jan;66(1):132-43; discussion 143-4
references.pmid: 19131816
references.citation: Ann Surg. 2011 Mar;253(3):451-2
references.pmid: 21239983
references.citation: Cochrane Database Syst Rev. 2009 Oct 07;(4):CD007424
references.pmid: 19821415
references.citation: Cochrane Database Syst Rev. 2003;(3):CD000255
references.pmid: 12917890
references.citation: Emerg Med Pract. 2012 Apr;14(4):1-23; quiz 23-4
references.pmid: 22567808
references.citation: J Trauma. 2002 May;52(5):896-901
references.pmid: 11988655
references.citation: J Trauma. 2001 Aug;51(2):279-85; discussion 285-6
references.pmid: 11493785
references.citation: Clin Neurol Neurosurg. 2010 Oct;112(8):691-4
references.pmid: 20580486
references.citation: Neurology. 2000 Dec 12;55(11):1738-40
references.pmid: 11113235
references.citation: J Neurosurg. 2013 Feb;118(2):397-404
references.pmid: 23216467
references.citation: J Trauma. 1998 Dec;45(6):997-1004
references.pmid: 9867039
references.citation: Ann Surg. 2013 Apr;257(4):621-32
references.pmid: 23470509
references.citation: Eur Spine J. 2012 May;21(5):837-43
references.pmid: 21898164