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Traumatische Dissektion der A. carotis interna nach HWS-Beschleunigungstrauma

Diagnostik und Therapie einer häufig übersehenen aber potenziell gefährlichen Begleitverletzung

Traumatic dissection of the internal carotid artery following whiplash injury

Diagnostic workup and therapy of an often overlooked but potentially dangerous additional vascular lesion

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Zusammenfassung

Wir berichten über den Fall eines 33-jährigen Mannes, der uns über den Notarztdienst in der Rettungsstelle unseres Klinikums vorgestellt wurde, nachdem er im Rahmen eines Verkehrsunfalls ein Hochrasanztrauma erlitten hatte. Neben einer Skaphoidfraktur bestand initial keine weitere neurologische Ausfallsymptomatik. Nach mehreren Stunden symptomfreien Intervalls entwickelte der Patient eine Dysarthrie als Akutmanifestation einer lokalen zerebralen Ischämie aufgrund einer traumatischen Dissektion der A. carotis interna rechts. Unter der eingeleiteten PTT-wirksamen Therapie mit unfraktioniertem Heparin kam es zu einer raschen kompletten Remission der neurologischen Symptome. Im Verlauf kam es zur Ausbildung eines Dissektionsaneurysmas. Der Patient blieb bislang unter der antikoagulativen Behandlung mit Phenprocoumon beschwerdefrei.

Wir möchten diesen Artikel nutzen, um neben der Darstellung dieses interessanten Falles das Diagnostik- und Therapieregime im Falle einer auftretenden Dissektion eines supraaortalen Gefäßes zu beleuchten, um dieser seltenen aber potenziell gefährlichen Komplikation rasch und suffizient begegnen zu können.

Abstract

We report on the case of a 33-year-old male patient who was brought to the emergency room of our hospital after suffering a high-energy trauma due to an automobile accident. Besides a scaphoid fracture there were no signs of any neurological deficits. After several hours without clinical symptoms the patient developed dysarthria as the first manifestation of local cerebral ischemia based on a traumatic dissection of the internal carotid artery. Under systemic high-dose heparin therapy, fast and complete remission of all neurological disorders could be achieved. In the course of time a dissecting aneurysm developed. Temporary anticoagulation with phenprocoumon was started in the meantime and no further complications have appeared up to now.

Besides presenting this absorbing case, this article highlights the diagnostic and therapeutic regime in cases of a traumatic dissection of supra-aortal arteries for rapid and adequate management of this rare but potentially dangerous complication.

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Authors and Affiliations

  1. Klinik für Allgemein- und Viszeralchirurgie, Akademisches Lehrkrankenhaus der Technischen Universität Dresden, Weißeritztal-Kliniken GmbH, Bürgerstraße 7, 01705, Freital, Deutschland

    M. Lenz

  2. Klinik für Unfall-, Wiederherstellungs- und Orthopädische Chirurgie, Weißeritztal-Kliniken GmbH, Freital, Deutschland

    T. Koch

  3. Klinik für Unfall-, Wiederherstellungs- und Handchirurgie, Städtisches Klinikum Dresden-Friedrichstadt, Dresden, Deutschland

    P. Bula & F. Bonnaire

  4. Institut und Poliklinik für Radiologische Diagnostik, Universitätslinikum Carl Gustav Carus Dresden, Dresden, Deutschland

    J. Bula-Sternberg

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  1. M. Lenz
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  2. J. Bula-Sternberg
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  3. T. Koch
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  4. P. Bula
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Correspondence to M. Lenz.

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Lenz, M., Bula-Sternberg, J., Koch, T. et al. Traumatische Dissektion der A. carotis interna nach HWS-Beschleunigungstrauma. Unfallchirurg 115, 369–376 (2012). https://doi.org/10.1007/s00113-011-2130-7

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  • DOI: https://doi.org/10.1007/s00113-011-2130-7

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