Canine Assault with Blunt Trauma to the Chest Causing Acute Ischemic Stroke

Ischemic stroke occurs in a significant subset of patients with blunt traumatic cerebrovascular injury (TCVI). The patients are most often victims of motor vehicle crashes or assaults, and suffer ischemic stroke due to injury of the extracranial carotid or vertebral arteries. A 60 year old male described walking in a park when a large dog jumped up striking him in the chest and causing forceful rotation of the neck, but no head injury was reported. Immediately after the incident the patient complained of dizziness, clumsiness of the left arm, and difficulty seeing to the left. Computed tomography angiography of the neck demonstrated 50% stenosis of the proximal right internal carotid artery secondary to mural thrombus. Prior to the event the patient had no known history of carotid disease. Magnetic resonance imaging of the brain showed numerous subcentimeter foci of acute ischemia in the right cerebral hemisphere within the right middle and posterior cerebral artery distributions. Most literature about TCVI and stroke has been published in trauma, general surgery, and neurosurgery journals because these patients are generally primarily managed by trauma surgeons. Because of the increasing prevalence and awareness of TCVI, it is important to bring this clinical entity to the attention of all medical providers