Retrospective Study
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Oct 26, 2020; 8(20): 4773-4784
Published online Oct 26, 2020. doi: 10.12998/wjcc.v8.i20.4773
Cerebral infarct secondary to traumatic internal carotid artery dissection
Guang-Ming Wang, Hang Xue, Zhen-Jie Guo, Jin-Lu Yu
Guang-Ming Wang, Hang Xue, Zhen-Jie Guo, Jin-Lu Yu, Department of Neurosurgery, The First Hospital of Jilin University, Changchun 130021, Jilin Province, China
Author contributions: Yu JL contributed to case conceptualization; Xue H and Wang GM contributed to data curation; Guo ZJ contributed to manuscript drafting; Wang GM and Yu JL contributed to manuscript review and editing.
Institutional review board statement: The study protocol was approved by the Institutional Review Board of the First Hospital of Jilin University.
Informed consent statement: Informed consent for publication of these cases was obtained from the patients or their relatives.
Conflict-of-interest statement: All authors have nothing to disclose.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Jin-Lu Yu, MD, MSc, PhD, Doctor, Professor, Department of Neurosurgery, The First Hospital of Jilin University, No. 71 Xinmin Avenue, Changchun 130021, Jilin Province, China. jlyu@jlu.edu.cn
Received: April 23, 2020
Peer-review started: April 23, 2020
First decision: April 29, 2020
Revised: August 16, 2020
Accepted: September 3, 2020
Article in press: September 3, 2020
Published online: October 26, 2020
Processing time: 186 Days and 2.6 Hours
Abstract
BACKGROUND

Traumatic internal carotid artery dissection (TICAD) is rare and can result in severe neurological disability and even death. No consensus regarding its diagnostic screening and management has been established.

AIM

To investigate the clinical presentation, imaging features, diagnostic workup, and treatment of TICAD.

METHODS

In this retrospective case series, emergency admissions for TICAD due to closed head injury were analyzed. The demographic, clinical, and radiographic data were retrieved from patient charts and the picture archiving and communication system.

RESULTS

Six patients (five males and one female, age range of 43-62 years, mean age of 52.67 years) presented with TICAD. Traffic accidents (4/6) were the most frequent cause of TICAD. The clinical presentation was always related to brain hypoperfusion. Imaging examination revealed dissection of the affected artery and corresponding brain infarction. All the patients were definitively diagnosed with TICAD. One patient was treated conservatively, one patient underwent anticoagulant therapy, two patients were given both antiplatelet and anticoagulant drugs, and two patients underwent decompressive craniectomy. One patient fully recovered, while three patients were disabled at follow-up. Two patients died of refractory brain infarction.

CONCLUSION

TICAD can cause catastrophic outcomes and even refractory brain hernia. Early and efficient diagnosis of TICAD is essential for initiating appropriate treatment. The treatment of TICAD is challenging and variable and is based on clinician discretion on a case-by-case basis.

Keywords: Internal carotid artery dissection; Brain infarction; Treatment; Prognosis

Core Tip: Traumatic internal carotid artery dissection is a rare and acute condition. Early diagnosis and intervention can improve the prognosis and quality of life of patients. Case presentations and a literature review may provide insight into the pathology, clinical manifestations, imaging features, diagnosis, and treatment.