We report a case of internal carotid arterial damage following blunt neck trauma. This rare mechanism of injury demands a high index of suspicion to enable prompt specialist management.

A 22-year-old man presented to hospital after sustaining blunt neck trauma. Rapid onset of stridor necessitated an emergency tracheostomy. Computed tomography angiography demonstrated a tear of the right internal carotid artery, which was repaired surgically.

Blunt carotid vessel injury, although rare, has a high mortality rate. Mechanisms of injury include hyperextension and contralateral neck rotation, a direct blow to the vessel, and laceration by adjacent bony structures. The ‘gold standard’ investigation for suspected blunt carotid vessel injury is catheter angiography, although this carries a small risk of stroke. Computed tomography angiography is a less invasive, alternative investigation which has almost equivalent accuracy. The extent of damage to the vessel wall will dictate treatment. In our literature review, we discuss the presentation, investigation and different treatment modalities available.

This case highlights an unusual mechanism of carotid artery injury, with a delayed, potentially fatal presentation. Such injury demands a high index of suspicion, and confirmation with specific investigations. Management is hazardous and requires experienced personnel in all aspects of care.