Case Report
Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. May 26, 2024; 12(15): 2664-2671
Published online May 26, 2024. doi: 10.12998/wjcc.v12.i15.2664
Imaging characteristics and treatment strategies for carotid artery occlusion caused by skull base fracture: Three case reports
Pei-Xin Shangguan, Ke-Chun Zhou
Pei-Xin Shangguan, Ke-Chun Zhou, Department of Emergency, Lishui Municipal Central Hospital, Lishui 323000, Zhejiang Province, China
Author contributions: Zhou KC contributed to manuscript writing and editing, data collection and data analysis; Shangguan PX contributed to conceptualization and supervision. All authors have read and approved the final manuscript.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: Author(s) certify that there is no conflict of interest related to the manuscript. If any potential conflict-of-interest exists, author(s) certify that it is fully disclosed.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Ke-Chun Zhou, Doctor, Surgeon, Department of Emergency, Lishui Municipal Central Hospital, No. 298 Kuocang Road, Lishui 323000, Zhejiang Province, China. 247025921@qq.com
Received: February 15, 2024
Revised: March 14, 2024
Accepted: April 9, 2024
Published online: May 26, 2024
Abstract
BACKGROUND

Traumatic internal carotid artery (ICA) occlusion is a rare complication of skull base fractures, characterized by high mortality and disability rates, and poor prognosis. Therefore, timely discovery and correct management are crucial for saving the lives of such patients and improving their prognosis. This article retrospectively analyzed the imaging and clinical data of three patients, to explore the imaging characteristics and treatment strategies for carotid artery occlusion, combined with severe skull base fractures.

CASE SUMMARY

This case included three patients, all male, aged 21, 63, and 16 years. They underwent plain film skull computed tomography (CT) examination at the onset of their illnesses, which revealed fractures at the bases of their skulls. Ultimately, these cases were definitively diagnosed through CT angiography (CTA) examinations. The first patient did not receive surgical treatment, only anticoagulation therapy, and recovered smoothly with no residual limb dysfunction (Case 1). The other two patients both developed intracranial hypertension and underwent decompressive craniectomy. One of these patients had high intracranial pressure and significant brain swelling postoperatively, leading the family to choose to take him home (Case 2). The other patient also underwent decompressive craniectomy and recovered well postoperatively with only mild limb motor dysfunction (Case 3). We retrieved literature from PubMed on skull base fractures causing ICA occlusion to determine the imaging characteristics and treatment strategies for this type of disease.

CONCLUSION

For patients with cranial trauma combined with skull base fractures, it is essential to complete a CTA examination as soon as possible, to screen for blunt cerebrovascular injury.

Keywords: Skull base fracture, Traumatic internal carotid artery occlusion, Blunt cerebrovascular injury, Imaging, Case report

Core Tip: This article emphasizes the importance of rapid computed tomography angiography examination for patients with skull base fractures, to detect potential carotid artery occlusions. This condition significantly complicates the prognosis due to its rarity, high mortality, and severe disability rates. Through the analysis of three distinct cases, this study showcases varied imaging characteristics and underscores the critical role of early diagnosis and tailored treatment strategies, including anticoagulation and decompressive surgery, in managing this severe complication effectively.