[Traumatic cerebral infarct in multistage dissection of the extracranial internal carotid artery]

A 26-year-old motorcyclist bounced against the side of a turning car with about the speed of 70 km/h. On admission to the clinic, he was awake with stable circulation. The main injuries were contusion of the chest with pneumothorax on the right side, blunt trauma of the abdomen without hematoperitoneum, and a fracture of the right femur. There was no visible trauma of the head, but only circumscribed cutaneous bleeding on the right side of the neck. About 16 h later, he showed an alteration in his level of consciousness and gradually "malignant" cerebral infarction of the left hemisphere with increasing intracranial pressure developed. Brain function began to cease and death occurred on the 4th day. The autopsy revealed neither traumatic damage to the skull, brain or cervical spine, nor were there pathological findings in the cerebral vessels. The main damage consisted of multiple dissections of the inner wall of the left internal carotid artery and the left medial cerebral artery. Proceeding from a temporarily sealed tear of the extracranial vessel, a large intramural hemorrhage had occurred between the media and adventitia and had compressed the lumen completely. The intracranial portion was closed by expanding thrombosis. These lesions are of indirect origin and are the result of vast overstretching of the arteries by the head turning over the edge of the top of the car. The victim was found at once after the crash with his body hanging the deeply dented side of the car and the head (with the helmet on) on the roof.