Carotid artery dissection plus subdural hematoma after a roller-coaster ride

Dissecção arterial carotídea e hematoma subdural após passeio em montanha-russa

A 31-year-old woman with history of antiphospholipid syndrome treated with warfarin reported two days after a roller-coaster ride, sudden onset of paresthesias in the right side of the face and in the right hand, followed by headache. Neuroimaging results are shown in Figures 1 and 2.

The “blood/fluid level” represented by the interface between plasma and sedimented blood (Figure 1) can be seen in hemorrhages related to bleeding disorders, among other causes¹. We suspect that the sudden head and neck movements during the roller-coaster ride contributed to the remarkably unusual combination of subdural hematoma and carotid artery dissection (Figure 2) in this patient.

Figure 1
(A) Initial head CT shows subdural hematomas in the left temporal region (arrowhead) and in the left tentorium (arrow), where a blood-fluid level can be observed; (B) Follow-up brain MR: axial FLAIR; and (C) SWI and sagittal postcontrast T1-weighted images demonstrate more clearly the same findings, the blood-fluid level (arrows in B to D) and the temporal subdural hematoma (arrowheads, B and C).

Figure 2
Digital subtraction angiography, oblique view, shows dissection of the proximal left internal carotid artery (arrow). There is an intimal flap and a patent false lumen.

Reference

• ¹
  Mittal MK, Burkholder DB, Wijdicks EF. Blood-fluid level on computed tomography head: a sign of warfarin-associated intraparenchymal hemorrhage. Am J Emerg Med. 2012;30(9):2079.e1-2. http://dx.doi.org/10.1016/j.ajem.2011.10.015
  » https://doi.org/10.1016/j.ajem.2011.10.015

Publication Dates

• Publication in this collection
  Dec 2014

History

• Received
  02 Aug 2014
• Reviewed
  21 Aug 2014
• Accepted
  09 Sept 2014