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Journal of Bone and Joint Surgery - British Volume, Vol 91-B, Issue 4, 536-539.
doi: 10.1302/0301-620X.91B4.22008  
Copyright © 2009 by British Editorial Society of Bone and Joint Surgery
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Delayed presentation of carotid artery dissection following major orthopaedic trauma resulting in dense hemiparesis

S. P. Edmundson, MB BCh, MRCS, Orthopaedic Senior House Officer1; K. M. Hirpara, MB BCh, BAO, MRCS(Ed), Orthopaedic Specialist Registrar1; R. S. Ryan, MB, MRCPI, FRCR, Consultant Radiologist2; T. O’Malley, MB, FRCP(Ed), Consultant Physician3; and P. O’Grady, MCh, FRCSI, FRCS(Tr & Orth), Consultant1

1 Department of Trauma and Orthopaedics
2 Department of Radiology
3 Department of Geriatric Medicine, Mayo General Hospital, Westport Road, Castlebar, County Mayo, Ireland.

Correspondence should be sent to Mr S. P. Edmundson; e-mail: stevenedmundson{at}yahoo.co.uk

We report a 30-year-old patient who was involved in a high-velocity road traffic accident and developed a left-sided hemiparesis, which was noted in the post-operative period following bilateral femoral intramedullary nailing. CT scanning of the brain revealed infarcts in the right frontal and parietal lobes in the distribution of the right middle cerebral artery. CT angiography showed occlusion of the right internal carotid artery consistent with internal carotid artery dissection. He was anticoagulated and nine months later was able to walk independently.

An awareness of this injury is needed to diagnose blunt trauma to the internal carotid artery. Even in the absence of obvious neck trauma, carotid artery dissection should be suspected in patients with a neurological deficit in the peri-operative period.






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Hip, Knee, Trauma, Upper limb, Foot & Ankle, Paediatrics, Oncology, Spine, Arthroplasty, General