Bilateral Carotid Bifurcation Thrombi Caused by Neck Overextension: Case Report and Review of the Literature

was discharged after 23 days with only a small motor deficit of the right thumb. The anticoagulation regimen was changed to acenocoumarol per os. The CCD scan was normal at 20 months after discharge, as well as at 3 years. Bilateral carotid thrombosis following a blunt cervicofacial trauma is infrequent, and bifurcation of attached thrombi without distal carotid dissection is rarer. In our case, sudden lateral neck overextension due to the automobile accident caused local intimal disrupture in both carotids and development of local thrombi; 3 days later, thrombi fragments probably detached following the patient’s uncontrolled fall, A24-year-old man was transferred to the emergency department due to mental confusion following slight alcohol consumption and a fall. Three days before, his car was suddenly hit on its left side by another car at a 90-degree angle; he suffered no external injury. The patient had right hemiplegia and severe dysarthria; he was irrational and semicomatose but hemodynamically stable. There were pulsations in all arteries with a right carotid bruit; no neck trauma was noted. Urgent head and neck computed tomography (CT) scans were negative. Color-coded duplex (CCD) sonography revealed floating thrombi at both internal carotids originating from the bifurcations. Angiography documented an extended contrast filling defect in the left internal carotid artery, causing an incomplete occlusion and a similar defect in the right internal carotid (Figure 1); no dissection was documented. Magnetic resonance imaging (MRI) of the brain, performed 2 days later, showed cortical infarcts in both brain hemispheres (Figure 2). The patient improved and was given dexamethasone and anticoagulation therapy with low molecular weight heparin (enoxaparine 60 mg bid subcutaneously); bed rest with neck immobilization was decided. Twenty-two days after admission, angiography showed complete disappearance of the mural thrombi (Figure 3). The patient Vascular and Endovascular Surgery Volume 42 Number 6 Dec 2008/Jan 2009 599-600 © 2009 SAGE Publications 10.1177/1538574408320528 http://ves.sagepub.com hosted at http://online.sagepub.com Images in Vascular Surgery