A healthy, 27-year-old man was admitted to hospital after being assaulted on 17 May, The Norwegian National Day, well known for children’s parades and general public celebration of the Norwegian Constitution. Two mandibular fractures were revealed and planned for surgery. Over the next few hours, he showed a decreased degree of consciousness. This was initially not considered severe, as alcohol intoxication is extremely common on this particular day. But when sometime later he developed a hemiparalysis and S-ethanol levels showed 0, a traumatic dissection with complete obstruction of the internal carotid artery was diagnosed (fig 1). Due to the delay in diagnosis and his jaw injury, he was given conservative treatment only. Fortunately, the contralateral cerebral blood supply was good, and despite a minor cerebral infarction, no neurological sequelae were sustained. His mandibular fractures were reduced and fixated with no complications.

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Figure 1

CT angiography shows complete obstruction of the right internal carotid artery (arrow). A minor cerebral infarction occurred.

Traumatic dissection of the carotid artery is very uncommon, but the possibility must be kept in mind. Such conditions may be fatal, even after minor trauma incidents. Delay in diagnosis, as in this case due to misinterpretation, may impair prognosis.