Cranial computed tomography in the diagnosis of symptomatic indirect trauma to the carotid artery.

Five patients who were involved in motor vehicle accidents sustained indirect, nonpenetrating carotid artery injuries leading to cerebral infarction. Four patients were conscious when a severe lateralized neurological deficit developed three to 12 hours after injury indicating the presence of a vascular injury and not a mass lesion. In 3 patients with occlusion of the main stem middle cerebral artery, computed tomographic (CT) scans performed between 1 and 7 hours after the onset of the ischemic signs were normal, but all scans performed after 11 or more hours revealed progressive edema in a vascular distribution leading to a midline shift. The fifth patient had a severe diffuse brain injury and no apparent clinical pattern of a posttraumatic vascular complication. Sequential changes on the CT scans similar to those of the other patients led to the proper diagnosis of vascular injury; this was later confirmed by arteriography. Indirect, nonpenetrating injury to the carotid artery should be suspected in the presence of the typical clinical pattern or when serial CT scans show the evolution of progressive edema in a distribution atypical for traumatic contusion.