A 69-year-old male, wearing a seat belt, driving his vehicle and having a frontal collision with another vehicle without loss of consciousness.
Initially there was hypotension (85/60), which was reversed with crystalloids.
The patient was admitted to the ICU. Chest trauma with bilateral pulmonary trauma, fracture, right costal fractures and open fracture type II of right calcaneal Gustille were observed.
He had a neck lesion on the belt.
Two hours after admission, right subtalar arthrodesis was performed.
Motor dysphasia was observed 24 h after the accident.
Cranial computed tomography (CT) showed a left temporoparietal corticosubcortical lesion compatible with acute ischemic infarction at the border, as well as moderate cortical territory signs.
The extracraneal Doppler ultrasound showed lower resistance indexes on the left side of both carotid arteries and internal carotid branches.
Cervical CT angiography showed a "double lumen" image in the left cervical internal carotid artery (ICA), there was punctiform contrast in the most distal portion of the ICA, returning to normal contrast-enhance.
Antiplatelet therapy was initiated with 200mg of acetylsalicylic acid (ASA) and the patient was discharged 4 days later with mild dysphasia.
