Disclosures: Christopher A. Trower, MS, DO: No financial relationships or conflicts of interest

Case Diagnosis: A 20-year-old female with no significant past medical history who developed a severe Traumatic Brain Injury and Right Middle Cerebral Artery stroke after a motor vehicle crash.

Case Description or Program Description: The patient presented as a trauma alert and was intubated upon arrival for airway protection in the context of significant facial trauma. Patient was found to be in hemorrhagic shock due to a retroperitoneal hematoma caused by bleeding of the peripancreatic vessels. After surgery patient was sent for stat neuroimaging of the head. Patient then developed worsening neurological deficits prompting neurosurgery to conduct an emergent decompressive craniectomy.

Setting: Consultant in Trauma Intensive care Unit

Assessment/Results: Initial computed tomography (CT) head without contrast revealed subarachnoid hemorrhage in the suprasellar cistern, hypoattenuation in multiple cortical lobes, traumatic injury to the right internal carotid artery (ICA) resulting in a suspected right anterior cerebral artery stroke. Follow up pancerebral angiogram 14 hours after initial CT identified complete occlusion of the intracranial right ICA , development of a right middle cerebral artery stroke was established.

Discussion (relevance): The highest rate of traumatic brain injuries (TBI) associated deaths is in the 15-24 age group due to motor vehicle accidents. TBIs represent a complex process involving a primary deficit from an external impact on the brain leading to secondary injury and inflammatory cascades that further cerebral damage. A confounding factor for stroke presentation in this patient could be secondary to an intracranial mass effect resulting from cerebral swelling. Although secondary stroke formation is rare, this case supports the possibility of TBI induced cerebral ischemia.

Conclusions: Stroke is a rare complication of TBIs but is beginning to receive more recognition nationwide as the number of TBI cases being reported increases. For patients with TBIs should be screened regularly for worsening neurological function and timely imaging to identify stroke formation to reduce patient morbidity.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/severe-traumatic-brain-injury-with-concurrent-traumatic-occlusion-of-the-intracranial-carotid-artery-resulting-in-right-middle-cerebral-artery-stroke-in-a-20-year-old-female-a-case-report/