A person may feel relatively normal immediately after a car accident and still develop a serious neurological complication later.
Head and neck trauma can sometimes damage blood vessels supplying the brain. In rare cases, this may lead to an arterial dissection or traumatic aneurysm that does not become obvious until hours or days after the injury.
During this episode of Mind Matters: Navigating Head Injuries and Concussions, treatment coordinator and registered nurse Kiley Como spoke with attorney Thomas Ozbolt of Shane Smith Law’s concussion and brain injury group about delayed vascular complications, warning signs, diagnostic testing, treatment, and the role of preexisting conditions.
How Trauma Can Damage a Blood Vessel
Thomas compared the brain’s blood vessels to highways carrying blood to different areas of the brain.
When trauma damages one of those highways, blood flow may become blocked, reduced, or disrupted.
This damage may happen after:
- A direct blow to the head
- Contact with a steering wheel or headrest
- A fall
- A sports injury
- Rapid acceleration and deceleration
- Sudden movement of the head and neck
A person does not necessarily need to strike their head. The force created by the body’s sudden movement may still affect the brain and nearby blood vessels.
What Is an Arterial Dissection?
An arterial dissection occurs when a tear develops in the inner lining of an artery.
Thomas compared it to a small tear inside a garden hose.
Blood may enter the tear and begin separating the layers of the artery wall. This can narrow the normal pathway for blood flow or create a place where a clot may form.
Depending on the location and severity, an arterial dissection may reduce blood flow to the brain and increase the risk of a stroke.
The symptoms may not appear immediately after the accident.
What Is a Traumatic Aneurysm?
A traumatic aneurysm occurs when an injured area of a blood vessel begins to weaken and bulge outward.
Thomas compared it to a balloon that becomes stretched and vulnerable as pressure builds inside it.
If the weakened area continues expanding, there may be a risk of rupture.
A ruptured aneurysm can cause bleeding around or within the brain and may require emergency treatment.
Although these conditions are uncommon, their potential consequences make it important to recognize warning signs after significant head or neck trauma.
Symptoms May Develop Later
One of the most important points from the discussion was that vascular complications may not be obvious at the accident scene.
Someone may initially believe they escaped the crash without a serious injury.
Hours or days later, they may develop symptoms such as:
- A severe or unusual headache
- Vision problems
- Dizziness
- Unequal pupils
- Nausea or vomiting
- Loss of consciousness
- Weakness or numbness
- Difficulty speaking
- Confusion
- Poor coordination
These symptoms can have several possible causes. Their presence does not automatically mean someone has an arterial dissection or aneurysm.
However, sudden, severe, or worsening neurological symptoms require prompt medical attention.
Arterial Dissections Can Lead to Stroke
An arterial dissection may interfere with blood flow or allow a clot to form.
If that clot blocks an artery supplying the brain, the person may experience a stroke.
Thomas noted that this may help explain why someone without a prior history of stroke develops one after a traumatic event.
Stroke symptoms may include facial drooping, weakness on one side of the body, speech problems, confusion, vision changes, and severe dizziness.
Emergency evaluation is critical because some treatments are most effective within limited time windows.
A Ruptured Aneurysm Can Cause Brain Bleeding
A traumatic aneurysm may cause a subarachnoid hemorrhage if it ruptures.
A subarachnoid hemorrhage is bleeding into the space surrounding the brain.
Kiley explained that these patients are often critically ill and may require intensive monitoring.
Bleeding can increase pressure inside the skull and interfere with the delivery of oxygen to brain tissue.
Medical teams may need to carefully control blood pressure, monitor neurological changes, manage breathing, and watch for additional complications.
How Doctors Look at the Blood Vessels
Routine brain imaging may not provide enough detail to identify every vascular injury.
Doctors may use tests designed specifically to examine arteries and blood flow.
Thomas discussed:
- CT angiography, also called CTA
- Magnetic resonance angiography, also called MRA
These tests provide detailed images of the blood vessels.
They may help doctors identify a tear, narrowing, clot, aneurysm, or another abnormality that requires treatment.
The type of imaging ordered depends on the symptoms, medical history, examination, and urgency of the situation.
Treatment Depends on the Condition
Treatment for an arterial dissection may include medication intended to reduce the risk of blood clots or stroke.
More severe injuries may require a procedure to repair or support the damaged vessel.
A traumatic aneurysm may also require surgery or an endovascular procedure.
Kiley discussed treatments in which a physician guides a catheter through an artery and into the blood vessels of the brain.
Tiny coils may be placed inside the aneurysm to reduce blood flow into the weakened area.
In other cases, a surgeon may place a clip across the neck of the aneurysm to prevent blood from entering it.
The appropriate treatment depends on the aneurysm’s size, location, shape, and whether it has ruptured.
Do Not Wait When Symptoms Are Severe
Thomas encouraged people not to take chances after a crash when concerning symptoms appear.
Someone experiencing a mild headache after an accident may not necessarily have a vascular emergency. However, a sudden severe headache, significant visual change, repeated vomiting, fainting, weakness, or confusion should not be ignored.
The safest course is to obtain medical evaluation rather than attempting to determine the cause at home.
A person only has one brain, and delaying care could allow a treatable condition to become more serious.
Preexisting Conditions May Increase Vulnerability
Some people enter an accident with medical conditions that make their blood vessels more vulnerable.
The episode discussed Marfan syndrome, a condition affecting the body’s connective tissue.
Connective tissue helps provide strength and support throughout the body, including within blood vessel walls.
A person with Marfan syndrome may have a greater risk of certain vascular problems, including tearing or enlargement of an artery.
That does not mean every person with the condition will experience an arterial dissection after an accident.
It means that trauma considered relatively mild for one person may have more serious consequences for someone whose blood vessels are already vulnerable.
Blood Thinners Can Also Affect Risk
Kiley also discussed people who take blood-thinning medications for conditions such as atrial fibrillation.
These medications may be necessary to prevent dangerous clots, but they can also increase the risk or severity of bleeding after trauma.
A person taking a blood thinner should tell emergency responders and medical providers immediately after an accident.
That information may influence decisions about imaging, monitoring, and treatment.
Patients should not stop prescribed medication on their own unless directed by a healthcare professional.
The Law Takes the Person as They Are
Thomas explained that an injured person should not be treated as less valuable because they were older or had a health condition before the accident.
A preexisting condition does not automatically excuse the person who caused the crash.
The important questions may include:
- What was the person’s health before the accident?
- Was the condition producing symptoms?
- Did the crash aggravate the condition?
- Did the trauma trigger a new complication?
- How did the person’s life change afterward?
A vulnerable person may suffer a more serious injury from the same event than someone who was completely healthy.
The responsible party generally does not get to choose the condition of the person they injure.
Preexisting Does Not Mean Unrelated
Insurance companies may point to a preexisting condition and argue that the accident did not cause the current medical problem.
However, an underlying vulnerability and a traumatic cause can exist at the same time.
For example, Marfan syndrome may make an artery more susceptible to injury. The car accident may still be the event that caused the artery to tear.
Medical evidence is needed to evaluate that connection.
The analysis should focus on how the person functioned before the accident, what trauma occurred, when symptoms appeared, and what the diagnostic testing revealed.
Report Your Complete Medical History
Patients should tell their medical providers about:
- Recent accidents or falls
- Prior vascular conditions
- Connective tissue disorders
- Blood-thinning medications
- Previous strokes or aneurysms
- New or worsening symptoms
- When the symptoms began
Doctors can only make decisions based on the information available to them.
Providing a complete and accurate history may help them select appropriate tests and recognize risks that would otherwise be easy to miss.
Continue Monitoring After the Crash
Feeling fine at the scene does not always mean every injury has been ruled out.
After a significant head or neck trauma, the injured person and family members should pay attention to neurological changes.
Seek immediate care for severe headaches, vision loss, unequal pupils, fainting, vomiting, weakness, speech changes, confusion, or other alarming symptoms.
Arterial dissections and traumatic aneurysms are not the most common results of a car accident, but they can be life-threatening when they occur.
Early recognition, appropriate vascular imaging, and timely treatment may make a critical difference.
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