title: Delayed Presentation of a Carotid Artery Dissection Following Blunt Trauma in a Young Adult with Minimal Risk Factors.
abstract: A 22-year-old woman presented to the emergency department (ED) after suffering injuries as a restrained driver in a head-on motor vehicle accident. Upon presentation to the ED, her Glasgow Coma Score (GCS) was 15. A computed tomography (CT) of the head and neck was negative. She was taken to surgery for orthopedic injuries. Recovery from general anesthesia was somewhat prolonged due to somnolence. Roughly two hours after transfer, her family noticed that she was not moving her left arm. Trauma staff noted she had a new left hemiparesis. She was promptly taken for a repeat head CT which showed a dense area of ischemia in her right cerebral hemisphere, in the distribution of the right middle cerebral artery (MCA). A CT angiogram of the head and neck revealed a large dissection of the right carotid artery below the level of C2-C3, complete occlusion of the right internal carotid artery beginning 2 cm superior to the bifurcation, and developing cerebral edema with subsequent leftward shift.
authors.affiliation: Louisiana State University Health Sciences Center Emergency Medicine Residency Program, Baton Rouge, LA.
authors.forename: Jason
authors.initials: J
authors.lastname: Talburt
authors.affiliation: Louisiana State University Health Sciences Center, School of Medicine, Department of Surgery.|Our Lady of the Lake Regional Medical Center.
authors.forename: Steward T
authors.initials: ST
authors.lastname: Cayton
authors.affiliation: Louisiana State University Health Sciences Center's School of Medicine, Department of Emergency Medicine.|Louisiana State University Health Sciences Center.
authors.forename: Shannon
authors.initials: S
authors.lastname: Alwood
authors.affiliation: Louisiana State University Health Sciences Center's School of Medicine, Department of Emergency Medicine.|Our Lady of the Lake Regional Medical Center.
authors.forename: Mandi
authors.initials: M
authors.lastname: Musso
mesh_terms: D000063:Accidents, Traffic; D020215:Carotid Artery, Internal, Dissection / Q000000981:diagnostic imaging* / Q000209:etiology; D054022:Cerebrum / Q000000981:diagnostic imaging*; D000072226:Computed Tomography Angiography; D005260:Female; D015600:Glasgow Coma Scale; D006801:Humans; D021621:Imaging, Three-Dimensional; D012307:Risk Factors; D014949:Wounds, Nonpenetrating / Q000150:complications* / Q000209:etiology; D055815:Young Adult