1532 - From Brain Trauma to Vascular Drama: Diagnosis of Internal Carotid Artery Dissection in Inpatient Rehabilitation

Case Diagnosis: Internal Carotid Artery Dissection after Traumatic Brain Injury

Case Description: This is the case of a 72-year-old male with multiple comorbidities who presented to the emergency room after a fall and was found to have a left subdural hematoma that was treated conservatively without surgical intervention. However, the patient was found to have balance issues and impaired mobility and self-care. Once stabilized, he was admitted to inpatient rehabilitation. Unfortunately, the patient had persistent headaches associated with eye pain and photophobia. Despite medical management, the headaches remained refractory and significantly hindered the patient's progress in rehabilitation. An ophthalmologic evaluation revealed Horner syndrome. This finding raised concern regarding possible underlying vascular pathology, prompting further investigation. The patient was found to have carotid dissection and was promptly discharged to a higher level of care for neurological monitoring.

Discussions: Traumatic carotid artery dissections (TCAD) afflict approximately 1% of patients with blunt injury mechanisms and is frequently initially unrecognized. Clinical presentations include headache, neck pain, tinnitus, Horner syndrome and cranial neuropathies, most of these occurring within 24 hours of the inciting trauma. With medical treatment, regression of the dissection is radiologically observed in majority of cases; however, neurological sequelae such as ischemic stroke and various degrees of stenosis may occur.

Conclusions: Though TCAD is a relatively rare complication of traumatic brain injury, it is important to remain vigilant of this complication that is associated with increased morbidity and further neurologic deterioration of already vulnerable traumatic brain injury patients.