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Vol. 10. Issue 4.
Pages 309-312 (January 1999)
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Vol. 10. Issue 4.
Pages 309-312 (January 1999)
Lesiones traumáticas de la carótida interna en la infancia. Revisión de tres casos
Traumatic carotid injury in childhood. Review of three cases
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J.M. Coca, R. Sarabia, J.I. Díaz de Tuesta, F. San Emeterio
Servicio de Neurocirugía. Hospital Univeróiitario. Valladolid
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Resumen

Se presentan tres pacientes de 2, 14 y 15 años de edad que fueron diagnosticados de una lesión traumática de la carótida interna. Los tres casos fueron estudiados con Tomografía Computarizada (TC) y arteriografía cerebral, así como Resonancia Magnética (RM) en el más reciente.

El hecho de que la TC sea el estudio complementario más empleado en el estudio del trauma craneal, dificulta el diagnóstico de lesiones vasculares carotídeas con el consiguiente retraso en la aplicación de medidas terapéuticas y empeoramiento del pronóstico. Tan sólo si se mantiene la sospecha de lesión vascular y se realizan arteriografías precoces, antes de que se instauren las lesiones por infarto, se podrían tratar estas lesiones con alguna garantía de éxito. En nuestros casos el diagnóstico se efectuó ante cuadros clínicos ya instaurados, y aunque las medidas terapéuticas que se adoptaron fueron diferentes en los tres casos, su aplicación fue tardía. Los cuadros de déficit neurológico que condujeron al diagnóstico no se modificaron, si bien no hubo mortalidad entre los pacientes.

El seguimiento de los pacientes ha sido de 10, 8 y 3 años, respectivamente, persistiendo la imagen de infarto en la TC y RM, a pesar de asistir en algún caso a una revascularización arteriográfica progresiva.

Palabras clave:
Lesión carotídea traumática en infancia
Traumatismo craneoencefálico
Complicaciones del traumatismo craneoencefálico
Abstract

We present three patients aged 2, 14 and 15 years respectively, who suffered traumatic carotid injury. They were studied by CT and angiography, and the most recent patient also had MR imaging.

The fact that CT has become the more reliable and extended study for diagnosis in cranial trauma patients, is crucial in underdiagnosing vascular lesions. Only a high index of suspicion and the practice of angiographical studies allows sorne degree of success in treating these vascular lesions and preventing their serious consequences in terms of high mortalíty and morbility rates (cerebral infarcts).

Our three patients were diagnosed angiographically only after their neurological deficits were already installed. Although treatment options were different in each case, they were applied too late within the course. We had no mortality, but neurological sequelae were unchanged after treatment through a follow-up period of 10, 8 and 3 years respectively. Even though in one patient we have confirmed angiographic revascularization, the CT and MR show a clearly defined area of cerebral infarct.

Key words:
Traumatic carotid injury in childhood
Cranial trauma
Complications of cranial trauma

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