Traumatic internal carotid artery injuries: do we need a screening strategy? Literature review, case report, and forensic evaluation

Abstract

: Internal carotid artery dissection (ICAD) represents the cause of ictus cerebral in about 20% of all cases of cerebral infarction among the young adult population. ICAD could involve both the extracranial and intracranial internal carotid artery (ICA). It could be spontaneous (SICAD) or traumatic (TICAD). It has been estimated that carotid injuries could complicate the 0,32% of cases of general blunt trauma and the percentage seems to be higher in severe multiple traumas. TICAD is diagnosed when neurological symptoms have already occurred, and it could have devastating consequences, from permanent neurological impairment to death. Thus, even if it is a rare condition, a prompt diagnosis is essential. There are no specific guidelines regarding TICAD screening. TICAD is mainly correlated to motor vehicle accidents (94/227), specifically to car accidents (39/94), and to direct or indirect head and cervical trauma (76/227). Nevertheless, TICAD should be considered when a young adult or middle-aged patient presents after severe blunt trauma. Understanding which kind of traumatic event is most associated with TICAD could help clinicians direct their diagnostic process. Herein, a review of the literature concerning TICAD has been carried out to highlights its correlation with specific traumatic events. As well, a case report is presented to discuss TICAD forensic implications.