carotid traumatic embolism
Introduction
Introduction to carotid traumatic embolism The common carotid artery is the main artery of the head and neck, and the upper thyroid cartilage branches into the internal carotid artery and the external carotid artery. The incidence of traumatic embolism is higher in the internal carotid artery. Because the internal carotid artery mainly supplies blood to the brain and the visual device, the embolization has serious consequences. Internal carotid artery embolization can occur in the cervical segment, the rock segment, the cavernous sinus segment or the upper segment of the bed. According to the analysis of 70 cases, 85% occurred in the neck segment and 10% in the rock segment. Internal carotid artery embolism occurs in the neck contusion, the patient may have a transient ischemic attack, followed by neurological symptoms, which is characteristic of internal carotid artery embolism. Relieving vasospasm and anticoagulation therapy can control the development of thrombosis. If necessary, the internal carotid artery is used for thrombectomy. basic knowledge The proportion of illness: 0.001% Susceptible people: no special people Mode of infection: non-infectious Complications:
Cause
Cause of carotid traumatic embolism
The artery is suddenly pulled (30%):
In the case of contusion, if the neck is excessively stretched or twisted, or the external force causes the brain tissue to be displaced, the internal carotid artery fixed at the upper end of the cavernous sinus is suddenly pulled. When the neck is severely twisted, the internal carotid artery also hits the cervical vertebra. On the protrusion, the wall of the arterial tube was contused.
Direct injury to the artery (30%):
Direct injury to the artery: neck contusion can directly squeeze the carotid wall, blunt trauma in the oral cavity and oropharynx can also affect the carotid wall through the tissue around the tonsils.
Craniocerebral trauma and skull base fracture (15%):
The internal carotid artery is often contused in the bone canal.
Carotid atherosclerotic lesions (15%):
After the contusion, the atherosclerotic block is easy to fall off and embolize.
Pathogenesis
At the time of trauma, the elastic outer membrane of the artery remains intact, the inner and middle layers are most vulnerable, the inner membrane is torn, curled and floated, the wound has thrombosis, gradually thickens, and extends up and down the arterial lumen. The carotid artery can be completely occluded, and internal carotid artery embolism often occurs 1 to 3 cm above the bifurcation of the common carotid artery.
The pressure of the large vein of the neck is very low, 00.3kPa (02mmHg), generally not susceptible to injury, but the carotid artery pressure is high, the average is 9.3kPa (70mmHg), its resistance is large, and it is easy to suffer from contusion and traction. Pulling, arterial spasm occurs first, followed by thrombosis. If the intima and middle layer of the artery are torn or interrupted due to contusion, higher arterial blood pressure can cause extensive exfoliation of the arterial intima, forming a stripping aneurysm. Many reports.
Prevention
Carotid traumatic embolism prevention
There is no effective preventive measure for this disease. Early detection and early diagnosis are the key to the prevention and treatment of this disease.
Complication
Carotid traumatic embolism complications Complications
There is no complication of this disease.
Symptom
Carotid traumatic embolism symptoms Common symptoms Trauma hematoma formation of a single internal carotid artery traumatic thrombus neck scratches or swelling
1. Neck hematoma: After carotid artery contusion, in the neck triangle, the neck triangle area may have hematoma formation.
2.Horner syndrome: often occurs in other neurological disorders, caused by injury and the upper cervical sympathetic chain adjacent to the internal carotid artery and the first cervical ganglion.
3. Transient ischemic attack: the same mechanism of cerebral ischemic attack as carotid atherosclerotic stenosis and thrombosis.
4. There is an intermediate awake period: there is a awake interval between injury and severe neurological symptoms, which is a feature of carotid contusion, from thrombosis to complete obstruction of the arterial lumen after vascular contusion In the case of neurological disorders, a process is required, ranging from hours to 2 weeks, with an average of 24 hours.
5. Limb paralysis or hemiplegia: The cerebral ischemic softening due to vasospasm or thrombosis, often with paralysis or hemiplegia, but the patient is clear-minded.
6. The facial artery or superficial temporal artery pulsation disappears: if the common carotid artery or external carotid artery has embolism, palpation of the facial artery or superficial temporal artery, the pulsation disappears.
Examine
Examination of carotid traumatic embolism
Carotid angiography
It can be seen that the blood vessel is bundled or conical, which is a typical manifestation of occlusion of the external carotid artery or internal carotid artery.
2. Determination of retinal arterial pressure.
3. Transcranial Doppler (TCD) examination.
It has certain diagnostic significance for internal carotid artery thrombosis.
Diagnosis
Diagnosis and differentiation of carotid traumatic embolism
Diagnostic criteria
History
There has been a history of neck contusion or a history of multiple trauma to the head, face and chest.
2. Clinical manifestations
There are signs or swelling of the neck, and the internal nervous system should be suspected of traumatic thrombus of the internal carotid artery. If the facial artery or superficial temporal artery disappears, it indicates that the common carotid artery or external carotid artery has been embolized, but attention should be paid to the neck. Arterial pulsation can be transmitted through the blood vessels of the thrombus, so the diagnostic significance of finger palpation is limited.
3. Auxiliary examination and diagnosis.
Differential diagnosis
Different from post-traumatic epidural hematoma or subdural hematoma, it is characterized by first conscious disturbance after trauma, followed by monoterpene or hemiplegia and other symptoms of elevated intracranial pressure, no hematoma in the neck, and internal and external carotid pulsations. However, traumatic brain injury and neck contusion often exist, and carotid angiography can be identified.
