Traumatic carotid artery dissection.

Traumatic carotid artery dissection is rarely seen as a cause of death in the forensic setting. Three cases of traumatic carotid artery dissection that demonstrate many of the typical features are presented. There is usually a history of some violent trauma to the head or neck, motor vehicle accidents being the commonest cause. The carotid artery may be injured anywhere from the common carotid portion to the cavernous sinus, resulting in infarction of the corresponding cerebral hemisphere. Clinically, symptoms may include loss of consciousness, hemiparesis, aphasia, and Horner's syndrome, these typically occurring after an interval of hours to days. Carotid artery injury may not be associated with evidence of external injury and initially may go undetected or may be misinterpreted in the setting of associated neck or head trauma. The commonest mechanisms are thought to be blunt neck trauma and neck hyperextension. The cases presented highlight the importance of early diagnosis if surgery is to be possible to avoid a fatal outcome.