[Treatment of traumatic carotid dissection]

Twelve traumatic internal carotid artery dissections were seen within a three-year period. All dissections were diagnosed upon onset of neurological deficits, although, seen retrospectively, there had been warning signs such as partial Horner's syndrome and neck pain, in the majority of cases prior to the neurological deficits. Panangiography and transcranial Doppler ultrasound were used to assess the cerebral haemodynamic situation. In only 3 of the 12 cases evidence of insufficient collateral circulation to the compromised carotid artery distribution was found, but radiological and Doppler sonographic signs of embolism to the middle cerebral artery were seen in the majority of patients. All patients were anticoagulated immediately following diagnosis. No primary reconstructive surgical procedures were performed. Five patients died within few days of massive cerebral infarction and the remaining 7 patients made a partial or complete recovery. Autoptic evidence for thrombo-embolic deposits in the middle cerebral or internal carotid artery was found in all 5 fatal cases at post mortem examination. Recanalisation of the dissected artery occurred within weeks in the majority of the surviving patients. The present series suggests that early diagnosis and immediate anticoagulation is the most important single factor for prognosis in traumatic carotid artery dissections.