Emergency Medicine Book

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Carotid Dissection in Blunt Neck Trauma

Aka: Carotid Dissection in Blunt Neck Trauma, Carotid Artery Injury in Blunt Neck Trauma, Traumatic Carotid Dissection
  1. See Also
    1. Neck Vascular Injury in Blunt Force Trauma
    2. Carotid Artery Dissection
    3. Cervical Artery Dissection
    4. Vertebral Artery Injury in Blunt Neck Trauma
    5. Blunt Neck Trauma
    6. C-Spine Trauma
    7. Trauma Evaluation
    8. Trauma Secondary Survey
    9. Denver Screening Criteria for Blunt Cerebrovascular Injury
  2. Epidemiology
    1. Traumatic Carotid Dissections are rare, but potentially devastating
    2. Traumatic Carotid Dissections are most common in children
      1. Children (esp. age <6 years old) account for 73% of Traumatic Carotid Dissections
      2. However occur in only 0.03% Pediatric Trauma patients
  3. Pathophysiology
    1. Predisposing factors in adults
      1. Carotid Atherosclerosis increases risk of carotid dissection with direct Trauma
    2. Predisposing factors in children (higher risk than adults)
      1. Intimal tear risk at ICA as it enters skull base at carotid canal
      2. Children at risk for carotid overstretching due to excessive neck hyperextension and rotation
        1. Large head to body ratio,
        2. Cranial cervical instability (weak neck Muscles, ligamentous instability risk)
  4. Background
    1. Blunt neck injury may result in occult and initially masked major neck vascular injury
    2. Risk of Carotid Artery Dissection and thrombosis
    3. May be initially asymptomatic with subsequent vessel thrombosis and hemispheric stroke within 72 hours
      1. Children are particularly high risk for missed injury (asymptomatic without initial neurologic signs)
  5. Evaluation
    1. See Neck Vascular Injury in Blunt Force Trauma

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