Treatment of small pseudoaneurysms with no symptoms remains controversial [ 2 ]. Data about naturally formed pseudoaneurysms are still lacking. It is impossible for all femoral artery pseudoaneurysms to form embolisms; at least one third of the patients require surgical treatment. Blunt injury to the carotid artery is usually found in the extracranial portion of the internal carotid artery near the basis cranii.
Intima exfoliation can cause stenosis or occlusion and might form pseudoaneurysm. Application of systemic anticoagulants heparin, warfarin, and antiplatelets can improve prognosis [ 3 ]. In patients for whom medical treatments were ineffective, direct surgical repair can be difficult due to the difficulty of distal end exposure, hence intervention using stenting and coil embolization treatment has been shown to be superior and achieve good results [ 4 , 5 , 6 ].
Patients with pseudoaneurysms caused by sharp injury to the carotid artery are usually unstable and sometimes demonstrate obvious symptoms of impeded respiratory tract, continuous enlargement of hematomas, and significant bleeding that require immediate surgical exploration.
To prevent long-term complications, pseudoaneurysm resection is necessary [ 7 ]. As the environment and foreign objects caused severe contamination to the wound when the patient was injured, and the patient had missed the opportunity to clean and stitch the wound within 8 h after the injury, the wound was already infected and the bacterial culture of the wound exudate showed saprophytic subspecies of saprophytic staphylococcus.
Hence, the patient underwent open drainage and antibiotics to control infection. Routine drainage should be placed for 24 h after surgery combined with antibiotics to control the infection.
Electroencephalography EEG monitoring and carotid artery shunt were used during surgery. EEG is extremely sensitive to reductions in cerebral blood flow; thus, it can be used to guide surgeons and anesthetists in intracranial aneurysm and other surgeries that need to block the blood-supplying arteries of the brain. Another study showed that for patients with carotid artery stenosis with or without symptoms, employing both EEG monitoring and selective carotid artery shunt during carotid endarterectomy CEA result in lower stroke rates than the sole use of intracavitary shunt; therefore, selective shunt might be better than non-selective shunt [ 9 ].
Not using shunting during CEA might eliminate risks such as the shifting of plaques at the shunt location and damage to distal arterial walls while also providing a better view of distal plaques during surgery [ 10 ]. The patient in this case was relatively young, and no obvious artery atherosclerotic plaques were seen during the surgery. Two pseudoaneurysms were formed due to the injury with breakages in both the anterior and posterior walls, and the duration of surgery was long. Intraoperative EEG monitoring and shunting were employed to prevent prolonged blockage of the common carotid artery.
The neck lies in the path of many important nerves including the cervical branch of the facial nerve, hypoglossal nerve, accessory nerve, vagus nerve recurrent laryngeal nerve , and cervical sympathetic trunk. Direct injury of the neck or pseudoaneurysm compression following carotid artery injury causes permanent or temporary dysfunction of these important nerves and structures, resulting in corresponding clinical symptoms.
For example, hypoglossal nerve injury causes curving of the tongue to the affected side, unilateral recurrent laryngeal nerve injury causes hoarseness, and cervical sympathetic trunk compression causes Horner syndrome. Penetrating cerebral injuries caused foreign bodies are rare in civilian neurosurgical trauma, although there are various reports to blast or gunshot injuries in warfare due to multiple foreign bodies like pellet and nails [ 11 , 12 ].
The hemodynamic instability which is the most commom perioperative complication usually is mild and resolved in one or 2 days. Perioperative control of blood pressure is very important. Also, cerebral ischemia is a common complication and can be reduced by intraoperative monitoring and selective shuting and improve blood circulation drugs. The clinical evaluation and perioperative monitoring of caradiac function are mandatory to prevent myocardial infarction.
On the basis of general anesthesia, local hypothermia and drug therapy and other comprehensive measures have a certain protective effect of the brain, but can not completely emimate cerebral ischemia-reperfusion injury [ 13 ]. Tacit coorperation of neurosurgeons and anesthetist is also the kye to success. In all, perioperatove and anesthesia management strategies are need for continued research in the field of the carotid artery penetrating injury.
Treatment of the carotid artery penetrating injury in this case can be summarized as follows: neck injury is an extremely urgent issue for which effective post-traumatic pressure hemostasis is the key to on-site first aid; a neck penetrating injury should not be considered a simple injury for which only simple stitching is applied; preparations should be made for complex circumstances including artery repair and treatments for combined injuries of other tissues such as injuries of the jugular vein, thyroid, and trachea; and attention should be paid to protecting brain tissues during surgery to reduce complications; and focus on perioperative management.
We report a unique case of carotid artery penetrating injury. Many departments jointly positive and effective surgical intervention are the key to reduce morbidity and mortality of carotid artery penetrating injury.
Endovascular-covered stent treatment of posttraumatic cervical carotid artery pseudoaneurysms. Australas Radiol. Article PubMed Google Scholar. Current trends in the management of iatrogenic cervical carotid artery injuries. Vasc Endovasc Surg. It is essential that equipment is well maintained and that stunning is carried out accurately, using the correct cartridge, to ensure that animals are effectively and irreversibly stunned.
Back to top. By continuing to browse the site you are agreeing to our use of cookies. Bleeding To prevent the risk of recovery, animals must be bled as soon as possible after stunning, ideally whilst still in the tonic rigid phase. Abattoir methods Cattle, deer and horses Bleeding should be carried out by an incision made with a sharp knife in the jugular furrow at the base of the neck, the knife being directed towards the entrance of the chest to sever all the major blood vessels arising from the heart Figure Figure Bleeding cattle Sheep and Goats Bleeding may be carried out in a similar way as for cattle Figure or by an incision made close to the head using a blade at least mm long to sever both carotid arteries and both jugular veins, i.
Figure Bleeding sheep Pigs A knife at least mm long should be inserted in the mid-line of the neck at the depression before the breast bone, and the skin raised with the knife point using light pressure and a lifting movement. Figure Cross-section of neck Stun-to-stick intervals The stun-to-stick interval is the time from application of stunning equipment to the start of bleeding.
This dizzy for a second thing lasted for a few hours, then I came home and went to bed. I have a nice little bruise on my neck, but my question is… How close was I to a serious injury or death? And should I still be concerned? Every situation is different and there is no way to answer your question accurately for your particular situation.
Baroreceptor compression is part of it but mostly it is a collapse of the artery from the external pressure and obstruction of blood flow to the brain—which requires constant blood flow to function and survive. So with significant compression of both arteries consciousness can be lost in seconds and brain damage and ultimately death follows. Dear Dr Lyle I am a Orthopedic Surgeon and have suffered from episodic right sisded cluster headaches since I was 18 years old ie since The bouts occur once a year and continue for 1 to 2 months with a frequency of 1 to 2 attacks per day lasting 1 to 2 hours.
I have practised both unilateral and bilateral carotid compression since during my episodes. I usually practised complete compression which led to brief loss of conciousness followed by recovery and and temporary releif of the pain followed by return of the headache followed by repetition of the procedure till the bout was over. Currently I am in a bout of cluster head ache and during this episode I have found that even partial compression of the ipsilateral carotid provides releif.
I have not noticed any deleterious effects inspite of almost 35 years of this exercise for releif of pain. I will appreciate your views. You may reply me on bks gmail. Strokes, cardiac arrest, and death are real possibilities. Talk to your neurologist about this. Any info on best way to position the rope to compress carotid by short drop hanging?
Thank you. My question is in regard to getting popped in front of my left ear a few days ago by my boyfriends elbow. His right elbow was coming up with force just as I was flopping down with force, and caught me just in font of my left ear at cheek bone.
Immediately the pain was excruciating. For the rest of the day, I could barely keep my eyes open, even when I was standing and talking.
I could barely open my mouth enough to eat a sandwich later in day and my face felt limp, or heavy…expressionless all day. Totally lethargic that day. The next day my energy was still very low.
I started googling after injury and it seems to have compressed the left external carotic artery and from my research this seems to run paralell to my injury.
I was wondering if a quick precise blow to the artery in that location could possibly do permanent or lingering damage that may need addressed? Rhonda—I never comment on real life medical situations as each is different. I suggest you talk with your own physician. Hi I was in a life and death mater with my ex in Sept he tried to kill me he chocked me standing n laying down.
Hit my head a lot etc.. I belive I died and came back when he was choking me on the ground.. I could not move or hear anything or feel anything. So did I die for a few minutes just wondering I think I did. Is that normal??? Robert nowak. Why do u use the word compression for a cut artery? Like chest compressions during CPR, which are intermittent—60 per minute to simulate the heart beat and push the blood along. Here it is to constrict the artery and thus restrict the blood flow.
They lie at the BACK of the throat. Jesus fuck. When symptoms persist, it is a stroke. Symptoms of a TIA or stroke may include:. If you or a loved one has any of these symptoms, call for medical help right away.
A TIA may be a warning sign that a stroke is about to occur. TIAs do not precede all strokes, however. The symptoms of a TIA and stroke are the same. A stroke is loss of blood flow ischemia to the brain that continues long enough to cause permanent brain damage.
Brain cells begin to die after just a few minutes without oxygen. The disability that occurs from stroke depends on the size and location of the brain that suffered loss of blood flow. This may include problems with:.
Recovery also depends on the size and location of the stroke. A stroke may result in long-term problems, such as weakness in an arm or leg. It may cause paralysis, loss of speech, or even death. The symptoms of carotid artery disease may look like other medical conditions or problems. Always see your doctor for a diagnosis. Along with a complete medical history and physical exam, tests for carotid artery disease may include:.
Listening to the carotid arteries. For this test, your doctor places a stethoscope over the carotid artery to listen for a sound called a bruit pronounced brew-ee. This sound is made when blood passes through a narrowed artery.
A bruit can be a sign of atherosclerosis. But, an artery may be diseased without producing this sound. Carotid artery duplex scan.
This test is done to assess the blood flow of the carotid arteries. A probe called a transducer sends out ultrasonic sound waves.
When the transducer like a microphone is placed on the carotid arteries at certain locations and angles, the ultrasonic sound waves move through the skin and other body tissues to the blood vessels, where the waves echo off of the blood cells. The transducer sends the waves to an amplifier, so the doctor can hear the sound waves. Absence of or faintness of these sounds may mean blood flow is blocked. MRI scan. This procedure uses a combination of large magnets, radiofrequency energy, and a computer to make detailed images of organs and structures in the body.
For this test, you lie inside a big tube while magnets pass around your body. Magnetic resonance angiography MRA. This procedure uses magnetic resonance technology MRI and intravenous IV contrast dye to make the blood vessels visible. Contrast dye causes blood vessels to appear solid on the MRI image so the doctor can see them. Computed tomography angiography CTA.
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