Document Detail


Blunt carotid artery injuries: difficulties with the diagnosis prior to neurologic event.
MedLine Citation:
PMID:  10372637     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: To evaluate the incidence, timing of diagnosis, clinical factors for adverse outcome, and role of anticoagulant, surgical therapy, or endovascular intervention for patients with blunt carotid artery injury (BCAI). METHODS: Retrospective review of the records of patients who sustained BCAI between 1987 and 1997. RESULTS: There were 18 men and 12 women, with an average age of 29 years. The diagnosis of BCAI was initially suspected in 15 patients after a major or new neurologic event, and in 15 patients after changes were shown by computed tomography. BCAI was confirmed by arteriography in 29 patients and by magnetic resonance angiography in 1 patient. Treatment consisted of antiplatelet therapy (n = 9), anticoagulation (n = 8), surgical repair (n = 6), observation (n = 4), and endovascular embolization (n = 3). With some type of treatment, 14 patients with no neurologic deficits remained stable; however, treatment improved the final neurologic outcome in 8 patients (20%). Three patients remained with severe deficits, and five patients died. CONCLUSION: The consequences of BCAI may be devastating. In our study, there were no reliable means to suspect this injury before neurologic symptoms or abnormalities show on computed tomographic scan. Although external signs are occasionally helpful, most patients have no pattern of injury to suggest BCAI. For patients whose findings after neurologic examination do not correlate with those on the computed tomographic scan, an immediate angiogram is indicated. Occasionally, a proximal injury can be surgically repaired, but in most patients, anticoagulation therapy appears to be the best treatment to avoid or improve neurologic deficits.
Authors:
E H Carrillo; D L Osborne; D A Spain; F B Miller; S O Senler; J D Richardson
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  The Journal of trauma     Volume:  46     ISSN:  0022-5282     ISO Abbreviation:  J Trauma     Publication Date:  1999 Jun 
Date Detail:
Created Date:  1999-07-14     Completed Date:  1999-07-14     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  0376373     Medline TA:  J Trauma     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  1120-5     Citation Subset:  AIM; IM    
Affiliation:
Department of Surgery, University of Louisville School of Medicine, University of Louisville Hospital, Center for Advanced Surgical Technologies, KY 40292, USA. ehcarr01@ulkyvm.louisville.edu
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MeSH Terms
Descriptor/Qualifier:
Adolescent
Adult
Algorithms
Brain Diseases / etiology,  therapy
Carotid Artery Injuries*
Child
Female
Humans
Incidence
Male
Middle Aged
Wounds, Nonpenetrating / complications,  diagnosis*,  epidemiology,  therapy
Comments/Corrections
Comment In:
J Trauma. 1999 Dec;47(6):1163-4   [PMID:  10608558 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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