Occult carotid artery injury related to automobile seat belts

A 24-year-old woman had a clinically occult injury of the carotid artery from the shoulder seat belt restraint in a motor vehicle accident. Acute thromboembolism and hemiplegia occurred two hours after her admission to the emergency department. There were contusions of the neck and chest (seat belt sign) but no associated injuries of the cervical spine, mandible, larynx, or brachial plexus. The diagnosis was made by carotid arteriography after the occurrence of thromboembolism. Early clinical suspicion, diagnosis, and surgical repair of the artery are necessary to prevent delayed or recurrent thromboembolism and stroke. Carotid artery and duodenal injuries in this patient were related to improperly fitting seat belts. The current useful preventive measures are adjustment of seat belts to individual body habitus and the regular use of snugly adjusted belts.