Massive ishaemic stroke as a fatal consequence of a mild head trauma - case report

Posttraumatic ischemic stroke after minor head injury is a rare and unexpected event. There are 65 cases of middle cerebral artery (MCA) occlusion described in the literature. Arterial dissection, cerebral vasospasm and thrombosis have been postulated as the possible pathogenetic mechanism. A case is presented of a 40-year-old man having sustained a minor head injury as a driver in a car accident. Twenty-four hours after the accident, he became soporous and was admitted to intensive care unit, where magnetic resonance imaging revealed mild brain edema on the left side with slight shift on the opposite side. He was transferred to our institution. Control computed tomography (CT) scan revealed edema and shift progression. Two days later, repeat CT scan showed further progression and the patient underwent decompression craniotomy; the patient died in two days. This case report points to the need of due attention be paid in any case of minor head injury where complications develop within 24 hours because a relatively mild head injury may be a cause and co-factor in the etiology of fatal stroke.