[Traumatic injury of the internal carotid artery in the extracranial segment. Description of a severe late complication].

Blunt traumatic injury to the extracranial internal carotid artery may lead to a dissection with resultant stenosis, occlusion, or a dissecting aneurysm. Delayed clinical presentation weeks, months, and even years after the injury is rare, but has important diagnostic, therapeutic and forensic implications. In the current era, where computed tomography is replacing angiography as the main diagnostic procedure, it is extremely important to keep this diagnosis in mind. We report the case of a 31-years-old male patient, who did well after a motorcycle accident with head and neck injury for six years. Since then he only showed left-side Horner's syndrome, which unfortunately was ignored. In 1993 the patient developed occlusion of central retinal artery, and after a therapy with streptokinase he presented with right-side palsy and complete aphasia. CT-scan revealed a large edematous infarction in the middle cerebral artery territory. Transfemoral digital subtraction angiography however demonstrated a dissecting aneurysm of the left extracranial internal carotid artery as the source of intracranial embolization. Severe sequelae of this kind can only be warded of by early diagnosis and proper surgical therapy of vascular injury. Therefore even minimal symptoms suggesting the possibility of a traumatic injury to the carotid artery are recommending timely angiographic investigation.