Carotid artery pseudoaneurysm resulting from an injury to the neck by a fouled baseball

Objective: Blunt carotid artery injury resulting in either dissection or pseudoaneurysm is a rare entity that can result in significant morbidity and mortality if undiagnosed. Although unavoidable in certain traumatic situations such as motor vehicle collisions, direct neck trauma in sports may be preventable with the use of proper protective equipment. Clinical presentation: The following report documents a case of extracranial carotid artery dissection resulting from a foul ball striking the upper, lateral neck of an umpire. The patient had transient right upper extremity monoparesis. He later presented with right hemiparesis and aphasia that resolved over several hours. Imaging studies demonstrated a left carotid pseudoaneurysm with evidence of left hemispheric embolic infarcts. Intervention: Systemic intravenous anticoagulation with heparin followed by oral anticoagulation with warfarin for 6 months, subsequently followed by aspirin monotherapy. Conclusion: The use of standard protective equipment did not adequately cover the patient's neck in the region of the cervical carotid artery. This case illustrates that modification in current catcher and umpire equipment could potentially avoid this rare but significant vascular injury. (C) 2007 Published by Elsevier B.V.