PDF(Pubmed)
Abstract：
Bilateral traumatic dissections of the cervical internal carotid artery (ICA) are rare complications of polytrauma. A thorough literature review was performed, and data from selected studies were analyzed to assess the trends in clinical presentation, modes of trauma, management protocols, and clinical outcomes. The reported outcomes were categorized and graded into optimal, intermediate, and poor outcomes. We describe a rare case of bilateral dissection of ICA in a 31-year-old woman who was involved in a motor vehicle accident. She had a Glasgow Coma Scale score of 9 and right-sided hemiparesis. Radiological findings revealed left upper ICA dissection, arterial intramural thrombus, and stenosis of the upper segment of the right ICA. She improved on conservative management and had a good clinical outcome at a three-month follow-up. Emergency physicians must be knowledgeable about such cases, as more than half of these trauma victims are initially asymptomatic on initial presentation. Specific diagnostic and therapeutic modalities should be implemented based on low threshold clinical suspicion to avoid missing these potentially disabling injuries and reduce morbidity and mortality. Computed tomographic angiography is recommended in cases with atypical clinical presentations, unexplained neurological deficits, or delayed-onset clinical deterioration. While antiplatelet and anticoagulant therapies are the mainstays of conservative management, endovascular and surgical management are only used in severe cases when medical treatment has failed, the artery has been completely transected, or there is active bleeding. Generally, good outcomes were reported in about two-thirds of those patients.
摘要：
颈内动脉（ICA）的双侧创伤性夹层是多发性创伤的罕见并发症。进行了全面的文献综述，并对选定研究的数据进行分析，以评估临床表现的趋势，创伤模式，管理协议，和临床结果。报告的结果被分类和分级为最佳，中间,和糟糕的结果。我们描述了一名发生机动车事故的31岁妇女中罕见的ICA双侧解剖病例。她的格拉斯哥昏迷评分为9分，右侧偏瘫。放射学发现显示左上ICA夹层，动脉壁内血栓,右ICA上段狭窄。她在保守治疗方面有所改善，并在三个月的随访中获得了良好的临床结果。急诊医生必须了解这种情况，因为这些创伤受害者中有一半以上最初是无症状的。应根据低阈值临床怀疑实施特定的诊断和治疗方式，以避免错过这些潜在的致残损伤并降低发病率和死亡率。对于临床表现不典型的病例，建议使用计算机断层扫描血管造影。无法解释的神经缺陷,或延迟发作的临床恶化。虽然抗血小板和抗凝治疗是保守治疗的支柱，血管内和外科治疗仅在严重的情况下使用，当药物治疗失败，动脉已经完全切断,或者有活动性出血.一般来说,这些患者中约有三分之二的患者报告良好结局.
