Traumatic Carotid Artery Dissection

Ian · Post by **Ian** » Fri Jul 19, 2002 3:49 pm

Recently admitted to a community hospital in Framingham, Mass:

A 21 yr old female with no significant past medical history was waterskiing 3 days prior to admission and fell with some twisting motion of her neck noted, but after some mild stiffness resolved later that same day, she felt her usual self. The day of admission she was jogging when she developed lightheadedness and diplopia which prompted a visit to the ER. Routine labs including CBC, coagulation tests and chemistries were normal. She was seen by the ER physician and a neurology consultant who noted anisocoria (R pupil 2 mm > than L, both responsive to light). Otherwise neurologic and general physical exam were normal, and the symptoms resolved after 15 minutes. He felt she probably had a migraine but given the lack of personal or family history he decided to get an MRI head and MRA head and neck (MR angiogram). These showed no evidence of stroke but an extracranial left internal carotid artery dissection with thrombus. It was later learned her anisocoria was old and had this been known, she might have been sent home without the MRI. Vascular surgery declined to intervene. The team considered getting a workup for hypercoagulable states but decided not to given that this was not spontaneous but rather traumatic thrombosis. She was placed on lovenox (twice daily heparin therapy) and coumadin (an oral blood thinner that takes several days to work, hence the lovenox) and was discharged home with caution that she had a high risk of stroke in the following 72 hours.

I spoke with the neurologic consultant who said he had a case series of dozens of carotid artery dissections, some spontaneous, many traumatic, and I will look into what I can glean from their records.

Bill Glasheen · Post by **Bill Glasheen** » Fri Jul 19, 2002 4:52 pm

Ian

I presume the moral of the story is that one cannot go thumping or twisting on the neck without some risk.

It's interesting to consider the type of trauma involved. If the boat were going fast enough, the twisting motion on the neck and/or the impact on the water may have been significant.

- Bill

M. Kelly · Post by **M. Kelly** » Fri Jul 19, 2002 6:23 pm

I am glad someone else has seen the literature on this subject. I wrote extensively about the complications and sequelae of blunt carotid artery trauma in the Dim Mak Medical Guide. I also addressed the literature on delayed neurological complications from blunt carotid artery trauma.

This type of injury has been documented to occur during assaults, grappling, and even from karate punches to the neck. All of which are referenced in the Dim Mak Medical Guide

------------------
Michael Kelly, DO
www.dimmak.net
The Science Behind The Legend

Ian · Post by **Ian** » Fri Jul 19, 2002 10:42 pm

Hopefully they'll have some more relevant to the subject at hand, that it, from combat. But we'll see. Found out about it at the tail end of my rotation and may have trouble digging there since its 45 min away... The next question is what is the real risk here... anything can happen from anything if you wait long enough, but that doesn't mean you worry about it. Huge task trying to figure that out, since events like these wouldn't frequently be reported unless they had such consequences. If that's the case how can you come up with a risk per trauma? People tend to publish what's interesting, so there will be no "carotid trauma with no sequelae whatsoever: a case series of 32 patients" in the literature.

Bill Glasheen · Post by **Bill Glasheen** » Fri Jul 19, 2002 11:55 pm

Dr. MK

I have your book, but what of the medical guide? I believe it was a file or something, and it wasn't compatible with my system. Any way you can pass it along (since your web page says it's free with the book). Thanks.

Ian

<BLOCKQUOTE><font size="1" face="Verdana, Arial">quote

The next question is what is the real risk here... anything can happen from anything if you wait long enough, but that doesn't mean you worry about it.

Thank you, thank you, thank you.

The strength of Dr. Kelly's work is the discussion of fundamental principles and the consideration of possible events. But this is where his work ends. Now I'm a numbers person, and so want to take the next step. As I see it, here is what I'd like to have (in an ideal world) for any specific technique or sequence.

1) Desired outcome(s)

2) Degree of difficulty (precision of targeting needed, force needed, time requirements, psychological factors, etc.)

3) Probability of success (possibly defined as a spectrum from Stun to Compliance to KO to RIP).

4) Probability of an adverse event (possibly several listed)

I have a measureable probability of an MI when I drive to work on Monday morning or during a workout, but that doesn't mean that a reasonably risk-averse individual would (or should) stop doing either of those activities.

FWIW.

- Bill

M. Kelly · Post by **M. Kelly** » Sat Jul 20, 2002 12:15 am

Dr Glasheen,
I thought I sent you a copy. I will resend it. If you have trouble with the ebook, let me know and I will send you a text version.

------------------
Michael Kelly, DO
www.dimmak.net
The Science Behind The Legend

M. Kelly · Post by **M. Kelly** » Sat Jul 20, 2002 12:22 am

By the way, I think you will find some of the answers to your questions in the ebook as there have been studies determing the probablity of blunt trauma induced damage to the carotid sinus.

------------------
Michael Kelly, DO
www.dimmak.net
The Science Behind The Legend

Bill Glasheen · Post by **Bill Glasheen** » Sat Jul 20, 2002 12:32 am

Yes, I remember now that you re-sent the document. My virus software says there is a virus attached, and so killed it.

I'll e-mail you directly. I have other questions.

- Bill