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In multiple trauma, blunt carotid artery injuries
(BCAIs) have occasionally been reported. However, bilateral blunt carotid
artery occlusions (Grade 4 BCAIs) associated with multiple trauma are rare, and
delays in diagnosis and treatment result in a lethal outcome. Here, we report
our experience with bilateral carotid artery occlusions. A 76-year-old female
suffered multiple traumas in a motor vehicle accident. On arrival at our
hospital, she presented in a coma, with left mydriasis and unreactive pupils.
Computed tomography (CT) showed bifrontal intracranial epidural hematoma and
fractures of the facial bone and anterior skull base, and osteoplastic
craniotomy was urgently undertaken for the epidural hematoma. However, the
comatose state and unreactive pupils persisted during the post-operative
course. Serial head CT findings showed progressive bilateral ischemic changes,
and radiological examinations revealed bilateral internal carotid artery
occlusions. We speculated that bilateral Grade 4 BCAIs had induced progressive
cerebral infarctions. The patient partially responded to anticoagulation
therapy with heparin infusion, but died of multiple organ failure on day 15.
When bilateral progressive ischemic changes are observed in a patient with
severe traumatic brain injury, bilateral Grade 4 BCAIs should be considered in
the differential diagnosis. CT angiography as part of whole-body CT at
admission may be effective for preventing delays in diagnosis and treatment of
bilateral Grade 4 BCAIs.