Blunt trauma to the carotid arteries.

Carotid artery dissection is a rare occurrence in the trauma patient. Two cases of blunt trauma resulting in carotid artery dissection are reported. Initial recognition by clinicians is often difficult because of the diverse clinical manifestations, the delay in presentation, and the associated multi-organ system injuries that accompany carotid artery dissection. Because the diagnosis of carotid injury is rarely suspected in patients with neurological deficits, the first diagnostic test performed is usually computed tomography (CT) of the head. Angiography should be strongly considered when the following occur: (a) Neurologic deficits are incompatible with CT findings; (b) there is monoparesis or hemiparesis with a normal mental status examination; (c) there is severe cervical trauma with an abnormal neurological exam; or (d) a basilar skull fracture is present in a patient with an abnormal mental status exam. Once diagnosed, the management of carotid artery dissection is complex and no generalized guidelines have been established.