Scratch marks or swelling in the neck

Introduction A scratch or swelling of the neck is one of the symptoms of traumatic embolization of the carotid artery. The common carotid artery is the main artery of the head and neck, and the upper thyroid cartilage branches into the internal carotid artery and the external carotid artery. The incidence of traumatic embolism is higher in the internal carotid artery. Because the internal carotid artery mainly supplies blood to the brain and the visual device, the embolization has serious consequences. Internal carotid artery embolization can occur in the cervical segment, the rock segment, the cavernous sinus segment or the upper segment of the bed. The patient may have a transient ischemic attack followed by a neurological condition characterized by internal carotid artery embolism. Relieving vasospasm and anticoagulation therapy can control the development of thrombosis. If necessary, the internal carotid artery is used for thrombectomy.

Cause

(1) Causes of the disease

1. Direct injury to the neck of the artery can directly compress the wall of the carotid artery. The blunt contusion in the oral cavity and oropharynx can also affect the carotid wall through the tissue surrounding the tonsils.

2. When the artery suddenly suffers from contusion, the neck is excessively stretched or twisted, or the external force causes the brain tissue to be displaced, and the internal carotid artery whose upper end is fixed to the cavernous sinus is suddenly pulled. When the neck is severely twisted, the internal carotid artery also hits the transverse process of the cervical vertebra, causing contusion on the wall of the artery.

3. Cranial neck trauma and skull base fractures The internal carotid artery is often contused in the bone canal.

4. After the atherosclerotic lesion of the carotid artery is contused, the atherosclerotic block is easy to fall off and embolize.

(two) pathogenesis

At the time of trauma, the elastic outer membrane of the artery remains intact, the inner and middle layers are most vulnerable, the inner membrane is torn, curled and floated, the thrombus is formed on the wound surface, and gradually thickens and extends up and down the arterial lumen. The carotid artery can be completely occluded. Internal carotid artery embolization often occurs 1 to 3 cm above the bifurcation of the common carotid artery. The pressure on the large vein of the neck is very low, 0 to 0.3 kPa (0 to 2 mmHg), and is generally not easily damaged. However, the carotid artery pressure is high, with an average of 9.3 kPa (70 mmHg). Its resistance is large, and it is easy to suffer from contusion and traction. Arterial spasm occurs first, followed by thrombosis. If the intima and medial layers of the artery are torn or interrupted by contusion, the higher arterial blood pressure can cause the intima of the artery to be widely peeled off to form a peeling property.

an examination

Related inspection

Neck examination, neck MRI, neck mobility test

1. Neck hematoma: After carotid artery contusion, there may be hematoma formation in the neck triangle and the anterior triangle of the neck.

2.Horner syndrome: often occurs in other neurological disorders, caused by injury and the upper cervical sympathetic chain adjacent to the internal carotid artery and the first cervical ganglion.

3. Transient ischemic attack: the same mechanism of cerebral ischemic attack as carotid atherosclerotic stenosis and thrombosis.

4. There is an intermediate awake period: there is a awake interval between the injury and the occurrence of severe neurological symptoms. This is a feature of carotid contusion. After vascular contusion, from thrombosis to complete obstruction of the arterial lumen, and neurological lesions occur, a process is required, ranging from hours to 2 weeks, with an average of 24 hours.

5. Limb paralysis or hemiplegia: Ischemia and softening of the brain due to vasospasm or thrombosis, often with paralysis or hemiplegia, but the patient is clear.

6. The facial artery or superficial temporal artery pulsation disappears: If the common carotid artery or external carotid artery has been embolized, palpation of the facial artery or superficial temporal artery, the pulsation disappears.

Differential diagnosis

Progressive neck mass: The neck mass is one of the most common diseases in the neck. Foreign scholar Skondalakis has concluded an "80% regularity" in the diagnosis of neck masses:

1 For non-thyroid neck masses, about 20% belong to inflammation, congenital diseases, and the remaining 80% belong to true tumors.

2 For patients with true tumors, about 20% are benign tumors, 80% are malignant sources, and gender-related, about 20% for women and 80% for men.

3 In neck malignant tumors, 20% are primary to the neck, and the vast majority are metastases (80%) derived from malignant tumors in other parts of the body.

4 80% of the metastases in the neck are from the head and face, and 20% are from the trunk of the human body. It must be noted that about 20% of all metastatic cancers in the neck, despite clinical, imaging, cytological and laboratory tests, eventually found no primary lesions, even occult Cancer.

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