What is a traumatic arterial
An arterial dissection occurs when
there is a tear in the lining of an
artery that prevents normal blood
flow to the brain. When the arterial dissection occurs from a trauma,
it is referred to as a traumatic arterial dissection (TAD).
In patients with TAD, the stroke
rate ranges from 3 to 44 percent,
depending on the severity of the
How may this injury occur?
A TAD may occur from physical
trauma to the head or neck from a
blunt injury, for example, a fall,
motor vehicle accident, or strangulation; or from hyperextension of
the neck, for example, whiplash,
a high speed motor vehicle accident, sports, exercise, or chiropractic manipulation.
How do the symptoms differ
from a traumatic brain injury?
A patient may initially have no
symptoms; or they may report
headache and neck pain, both of
which are common complaints to
many trauma injuries.
Moreover, the typical CT scan
initially done in hospital emergency rooms may show no abnormali-ties, as symptoms often develop
over a period of hours or days.
In addition, the diagnosis of a TAD
may be delayed or undiagnosed
due to treatment of other presenting problems related to trauma.
How can a neuropsychological
A TAD will present with a specific
pattern of impairment on neuropsychological testing depending
on the location of the brain tissue
damage. If the TAD was the result
of a motor vehicle accident, the individual may also show evidence
of traumatic brain injury on testing
in addition to a stroke.
Because a patient often complains of physical symptoms related to the TAD (e.g., headache, neck
pain) rather than cognitive deficits,
a neuropsychological exam is often not ordered. This is particularly
true in those cases where the TAD
did not cause obvious deficits.
However, a comprehensive neuro-
psychological exam should reveal
a pattern of impairment consistent
with the TAD, and also identify
subtle to severe symptoms.
In cases where an unequivocal
traumatic brain injury is known, a
neuropsychological exam should
also assist in identifying and discriminating between a TAD versus
a traumatic brain injury, each of
which has distinct implications for
recovery and outcome.
What may be the impact
to a case?
In cases where a significant traumatic brain injury has occurred, attorneys may settle on a diagnosis
of a traumatic brain injury only,
without attention being made to
the additional and devastating
effects of a TAD, if present.
Thus, for those patients who
have sustained a complicated
traumatic brain injury where there
is unequivocal evidence of intracranial damage, a TAD should be
ruled out medically and confirmed
via neuropsychological evaluation,
as its course and prognosis can
vary significantly from a traumatic
Approximately 1% of patients admitted to the hospital after a major
motor vehicle accident will have a Traumatic Arterial Dissection.
The course of recovery can be far more complicated than recovery
from a traumatic brain injury.
An estimated 37 – 58% of these patients have lasting neurological
problems and a higher mortality rate, compared with non-traumatic
DR. SUSAN BORGARO, NEUROPSYCHOLOGY ASSESSMENT SERVICES
Dr. Borgaro provides expert witness services; independent neuropsychological
exams and consultation locally and nationally, both plaintiff and defense.
She has extensive experience in traumatic brain injury, rehabilitation, recovery
and treatment issues, and is experienced in deposition and trial testimony.
The Under-Diagnosed Condition
that Can Follow a Head Injury