Autopsy and Case Reports
Autopsy and Case Reports
Article / Clinical Case Report

Traumatic injury to the internal carotid artery by the hyoid bone: a rare cause of ischemic stroke

Fernando Peixoto Ferraz de Campos; Marcia Yoshie Kanegae; Vera Demarchi Aiello; Pedro José dos Santos Neto; Tatiane Carneiro Gratão; Erasmo Simão Silva

Downloads: 10
Views: 2391


Central nervous system (CNS) ischemic events, besides being a common and devastating disease, are accompanied by severe disability and other morbidities. The cause of such events is not always that simple to diagnose, and among the young, a broad spectrum of possibilities should be considered. We present the case of a young man who presented two episodes of CNS ischemia with a 1 year gap between them, which occurred in the same situation while he was walking and carrying a heavy backpack. The second event first presented as a transient ischemic attack followed by a stroke the day after. The diagnostic work-up showed an indentation of the greater cornu of the hyoid bone over the internal carotid artery, which injured the media and intimal layers. At the arterial injury site, a micro thrombus was found, which explained the source of the embolic event to the CNS. The patient was operated on, and the procedure included the resection of the posterior horn of the hyoid bone, the resection of the injured segment of the internal carotid artery followed by carotid–carotid bypass with the great saphenous vein. The postoperative period and the recovery were uneventful as was the 5-month follow-up. We call attention to this unusual cause of stroke and present other cases reported in the literature.


Stroke, Brain Ischemia, Hyoid Bone, Carotid Artery diseases, Surgical procedures, Operative


McIntyre WB, Ballard JL. Cervicothoracic vascular injuries. Semin Vasc Surg. 1998;11(4):232-42. [PMID:9876030]

Ramadan F, Rutledge R, Oller D, Howell P, Baker C, Keagy B. Carotid artery trauma: a review of contemporary trauma center experiences. J Vasc Surg. 1995;21(1):46-56. [PMID:7823361] [].

Abdelaziz OS, Ogilvy CS, Lev M. Is there a potential role for hyoid bone compression in pathogenesis of carotid artery stenosis? Surg Neurol. 1999;51(6):650-3. [PMID:10369234] [].

Metz H, Murray-Leslie RM, Bannister RG, Bull JW, Marshall J. Kinking of the internal carotid artery. Lancet. 1961;1(7174):424-6. [PMID:13769898] [].

Quattlebaum JK Jr, Wade JS, Whiddon CM. Stroke associated with elongation and kinking of the carotid artery: long-term follow-up. Ann Surg. 1973;177(5):572-9. [PMID:4704042] [].

Stack CA, Cole JW. A diagnostic approach to stroke in young adults. Curr Treat Options Cardiovasc Med. 2017;19(11):84. [PMID:28948451] [].

Putaala J, Metso AJ, Metso TM, et al. Analysis of 1008 consecutive patients aged 15 to 49 with first ever ischemic stroke. The Helsinki young stroke registry. Stroke. 2009;40(4):1195-203. [PMID:19246709] [].

Wells DR, Archie JP Jr, Kleinstreuer C. Effects of carotid artery geometry on the magnitude and distribution of wall shear stress gradients. J Vasc Surg. 1996;23(4):667-78. [PMID:8627904] [].

Salzar RS, Thubrikar MJ, Eppink RT. Pressure-induced mechanical stress in the carotid artery bifurcation: a possible correlation to atherosclerosis. J Biomech. 1995;28(11):1333-40. [PMID:8522546] [].

Renard D, Rougier M, Aichoun I, Labauge P. Hyoid bone-related focal carotid vasculopathy. J Neurol. 2011;258(8):1540-1. [PMID:21327849] [].

Schneider CG, Kortmann H. Pseudoaneurysm of the common carotid artery due to ongoing trauma from the hyoid bone. J Vasc Surg. 2007;45(1):186-7. [PMID:17210407] [].

Kölbel T, Holst J, Lindh M, Mätzsch T. Carotid artery entrapment by the hyoid bone. J Vasc Surg. 2008;48(4):1022-4. [PMID:18992420] [].

Pearlman RC, Naficy MA, Koby MB, Nyanzu M. Carotid artery compression by the hyoid bone. Vasc Endovascular Surg. 2012;46(8):686-7. [PMID:22989429] [].

Hong JM, Kim TJ, Lee JS, Lee JS. Repetitive internal carotid artery compression of the hyoid: a new mechanism of golfer’s stroke. J Neurol Neurosurg Psychiatry. 2011;82(2):233-4. [PMID:20587482] [].

Tokunaga K, Uehara T, Kanamaru H, et al. Repetitive artery-to-artery embolism caused by dynamic movement of the internal carotid artery and mechanical stimulation by the hyoid bone. Circulation. 2015;132(3):217-9. [PMID:26195490] [].

Yukawa S, Yamamoto S, Hara H. Carotid artery dissection associated with an elongated hyoid bone. J Stroke Cerebrovasc Dis. 2014;23(8):e411-2. [PMID:25126696] [].

Janczak D, Skora J, Rucinski A, Szuba A. Recurrent syncope caused by compression of internal carotid artery by anomalous hyoid bone. Vasa. 2012;41(3):221-4. [PMID:22565624] [].

Publication date:

5a86d6a30e88252335bd8e8e autopsy Articles
Links & Downloads

Autops Case Rep

Share this page
Page Sections