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Sudden hemiplegia after a motorcycle accident

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A 21 year old previously healthy man lost control of his motorcycle and tumbled down to the bottom of an embankment. He suffered a brief loss of consciousness, got up, and, with pain in his left arm, pushed the motorcycle up the embankment back onto the side of the road. At that point, he developed a sudden onset of dysphasia and dense right hemiplegia.

At the hospital, he was found to have normal vital signs, a closed fracture of the left humerus, right hemiplegia with no other neurological deficit, and normal computed tomography of the head. Digital subtraction left internal carotid arteriogram was immediately carried out.


What does the carotid arteriogram show (figs 1 and 2)?
What is the best way to manage this patient?
What is the differential diagnosis of acute neurological deficit after trauma?
Figure 1

Lateral view of the patient's right internal carotid arteriogram using digital subtraction techniques shows a dissection.

Figure 2

Oblique view of the patient's left internal carotid arteriogram shows a dissection.

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