What is Carotid Contusion?
The neck contains several significant parts, including the carotid arteries found on both sides. Though damage to the carotid artery is unusual, it’s rarely an isolated event due to the close vicinity of other vital components. This artery can be injured by either sharp or blunt force. When sharp, it can cause heavy bleeding and build-up of blood (hematoma) that quickly affects the airway. When blunt, such trauma often starts a tear in the innermost layer of the artery (intimal dissection) and/or triggers hematoma. Injuries to the carotid caused by blunt trauma often lead to blood clotting with delayed neurological issues and can have mortality rates as high as 40%.
What Causes Carotid Contusion?
The common carotid artery is an important blood vessel found in the lower part of the neck, also known as zone I. Other vital structures in this region include parts of the aorta (the main blood vessel in the body), subclavian vessels (which supply blood to the arms, chest, and head), the esophagus (the tube that connects your throat to your stomach), the trachea (your windpipe), the spinal cord, and nerves in your neck.
Zone I extends from the chest opening at the bottom to the cricoid cartilage (a ring of cartilage around the windpipe) at the top. Injuries in this zone can be very serious and are associated with the highest rates of illness and death.
The middle part of the neck, zone II, goes from the cricoid cartilage to the angle of the jaw. Most injuries to the carotid artery occur in this zone, and they have the best outlook because the injuries there are easier to reach for surgical repair. The upper part of the neck, zone III, extends from the angle of the jaw to the base of the skull and is difficult to reach in case of injury.
When the carotid artery is injured without an actual cut or puncture wound, it often happens because of an extreme overextension of the neck or neck rotation. These actions can stretch the carotid artery, leading to tears and blood clots. Blunt trauma injuries to the neck can come from car accidents, sports injuries, strangulation, a direct hit to the neck, or excessive manipulation of the neck.
Risk Factors and Frequency for Carotid Contusion
Generally, serious injuries to the neck make up 5% to 10% of all severe injuries and are mostly seen in younger individuals. While the documented cases of blunt injuries to the carotid artery vary from 0.08% to 0.86% of all blunt trauma admissions, the exact number of these injuries is still not clear. This is largely due to underdiagnosing or completely missing the injury, especially when no symptoms are present.
Signs and Symptoms of Carotid Contusion
Carotid artery contusion, which is a bruise on the major artery in the neck, often has symptoms that develop more slowly than you might expect following a serious artery injury. This means that there may be delays in diagnosing and treating the issue, which could negatively impact recovery. People with this type of contusion may experience symptoms stemming from injuries to the larynx (voice box) and trachea (windpipe). These could include:
- Difficulty breathing
- Changes in voice, including hoarseness
- Difficulty swallowing
- Noisy breathing (stridor)
- Drooling
- Feeling of air bubbles under the skin (subcutaneous emphysema)
- Coughing up blood (hemoptysis)
Other structures such as the throat (pharynx) and the pipe that food goes down (esophagus) could also be affected, causing:
- Difficulty swallowing
- Saliva mixed with blood
- Blood in the stomach contents drawn out with a tube (nasogastric tube).
People may also experience neurological symptoms such as:
- Weakness
- Skin numbness or tingling sensation
- Paralysis or muscle weakness on one side of the body (hemiplegia or hemiparesis).
Serious signs of a carotid artery injury like an expanding bruise, bleeding that spurts with the pulse, signs of reduced blood supply to the brain, shock that doesn’t improve with fluids, or a new swishing sound heard with a stethoscope (bruit) could also be present.
If you’ve incurred blunt trauma to the carotid artery, particularly in the neck, this could result in traumatic cerebrovascular injury – a separate condition that can occur in addition to contusion. In many cases, symptoms such as mild to severe weakness on one side, serious neurological problems or even unconsciousness occur before reaching the hospital or before getting vessel imaging tests done.
Testing for Carotid Contusion
If you have a neck wound, you should not touch or interfere with it. This could cause you to choke, cough, or gag, which might disrupt a blood clot and lead to severe bleeding. If there is a suspicion of bruising or damage to the carotid artery (a major blood vessel in the neck), a special kind of scan called computed tomographic angiography is often used. This scan is quick to do and carries few risks. In a few minutes, it can be combined with other scans to provide a comprehensive picture for patients with multiple injuries. This type of scan is very good at giving clear images of different degrees and types of vessel injury, such as blockages, false aneurysm formation, internal tears, separation of the layers of the artery, and unintended connections between arteries and veins. Additionally, this kind of scan can spot other injuries in the soft tissues of the neck, the digestive and air passages, and the spinal cord.
Traditionally, a procedure called digital subtraction angiography has been considered the best way to image traumatic injuries to the carotid artery. This can pick up small defects on the inside of the artery and can identify clots or aneurysm formation inside the blood vessel. However, this procedure has some downsides, as it can be time-consuming for patients with multiple injuries, is invasive, is expensive, and not always readily available. Usually, this test is saved for those patients with an unclear diagnosis or clear need for a treatment that can be delivered through the blood vessels, since this form of imaging can be both diagnostic and therapeutic. Magnetic resonance imaging and angiography can help to spot sequelae (conditions caused by a previous disease or injury) of carotid artery trauma, but are not usually used in the initial investigation of a recent carotid artery injury.
Treatment Options for Carotid Contusion
If you’ve suffered a bruising or injury to your carotid artery, which is a major blood vessel in your neck, knowing the right course of action is vital. The treatment chosen depends on a few factors, including:
– How stable you are
– Your symptoms
– Other injuries you might have
– Any other health conditions you have
Before any treatment specific to your neck injury can begin, doctors need to ensure you’re stable overall. This is because missed or mismanaged neck injuries from trauma can carry a risk of mortality exceeding 15%. Up to 10% of neck injuries can also lead to breathing issues and pose a high risk of death, which is why securing the airway to help you breathe is crucial.
The treatment for a carotid artery bruise can range from merely monitoring you closely to administering medications that thin your blood, and in some cases, to surgical procedures to remove any blood clots.
If the injury involves the external carotid artery, a blood vessel that supplies blood to parts of your face and neck, doctors usually manage with conservative measures. This means they’d monitor your condition closely and control your symptoms as needed, without resorting to more invasive treatment.
Many studies suggest that medications that thin your blood or prevent clotting can improve neurological outcomes in patients with carotid artery bruising. The medication heparin, for instance, can help stabilize any clots present, dissolve clots through natural mechanisms, and prevent new clots from forming. About 45% of patients with strokes related to blunt carotid injuries recover well using this approach.
Another popular treatment choice involves antiplatelet agents, which are drugs that prevent blood clots from forming by inhibiting the clumping together of platelets in the blood. These can be easy to administer, and have been found to be as effective as heparin in preventing strokes and aiding recovery in patients with carotid injuries. In fact, treatment with either approach has been shown to reduce the risk of stroke from 64% in untreated patients to 6.8% in anticoagulated or anti-platelet treated patients.
However, these treatments need to be used cautiously in patients with multiple injuries due to the risk of bleeding. Importantly, they should not be used in patients who’ve recently had a traumatic brain injury with or without bleeding in the brain.
In certain cases, a direct surgical treatment might be needed to repair tears or significant damage to the carotid artery. The chosen procedure could involve sewing the tear, removal of plaque in the artery, or patch repair of the artery. In some situations, the damaged section might be removed and replaced with a vein graft. Surgical intervention is usually considered for patients displaying acute, focused neurological deficits or symptoms that suggest a stroke.
Following any arterial repair, a diagnostic procedure called an angiogram will be conducted to ensure proper blood flow and to confirm the absence of any remaining clots.
What else can Carotid Contusion be?
If someone is suspected of having a carotid contusion, which is an injury to their neck, there are several other potential conditions that the doctors might also consider. These conditions may have symptoms that are similar to the ones found in a carotid contusion:
- Acute hypoglycemia (low blood sugar)
- Carbon monoxide poisoning
- Possible fracture in the neck spine
- Cluster headache (a severe type of headache)
- Hemorrhagic stroke (bleeding in the brain)
- Herpes simplex virus (a common virus)
- Herpes zoster (also known as shingles)
- Ischemic stroke (a blockage in the blood supply to the brain)
- Migraine headache
- Neck injury
