Board Review

Never Bored Review 8/12/14 – Trauma

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A young man was standing on the corner, minding his own business, on his way to church, when he…

take a guess

Was assaulted.

EMS reports + LOC with 2 episodes of vomiting after, and amnesia of the entire event. He is still perseverating and unable to comply with a complete neurologic exam. You are smart enough to notice his Right pupil is much bigger than his Left and that his Left eye is more open than the other. You also notice he isn’t moving his Right arm or leg…

You rush him to the scanner expecting to see a big bleed and see…normal young kid brain.

The patient has a small pupil and an extra-open eye on the same side. What is the name of this syndrome and the third component?
Horner’s Syndrome. Ptosis, Mieosis, Anhydrosis

 

What is the diagnosis?
Carotid Artery Injury

 

When should you suspect this disease?

1. Neuro deficits after neck trauma or trauma involving intense neck flexion, rotation, or extension with normal head CT

2.High risk injuries such as: petrous fracture, lefort II or lefort III, diffuse axonal injury

3. Ischemic CVA on CT scan after trauma to head and/or neck

4. Epistaxis from an arterial source after blunt trauma

 

What test do you use to diagnose this?
CT angio of the neck, but, per EAST guidelines, the “gold standard” is angiogram

 

How do you treat this disease?
Anticoagulation and surgery.

 

Dr Andrew Grock and Dr. Sally Bogoch

Tintinalli’s

east guidelines http://www.east.org/resources/treatment-guidelines/blunt-cerebrovascular-injury

The views expressed on this blog are the author's own and do not reflect the views of their employer. Please read our full disclaimer here. Any references to clinical cases refer to patients treated at a virtual hospital, Janus General Hospital.
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andygrock

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1 comment for “Never Bored Review 8/12/14 – Trauma”

  1. boiyemhonlan
    August 21, 2014 at 10:01 am

    Pretty nice case… Thanks for reminding us of the carotid and vertebral artery injuries and what to look for on exam.

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