Introduction: The incidence of hemiplegia with traumatic brain injury was common with DAI, ICH, infarct and others. But the incidence of late onset hemiplegia was an uncommon finding. Herewith presenting 2 cases of late onset hemiplegia amongst the cases reported in the ER. The aim of this study is to investigate the incidence of late onset hemiplegia following traumatic head and neck injury and the severity of trauma.

Methods: This cross sectional study was conducted between March 2016 to August 2016 in the Department of Neurosurgery, Madras Medical College. Consecutive head injured patients on the basis of admission CT scan were prospectively evaluated. The severity of trauma was evaluated by determining Glasgow Coma Scale (GCS) score on admission. Repeat CT scan was taken if patient GCS falls, onset of any new neurological deficit, seizures or at the time of discharge

Results: Among these patients, 2 patients developed late onset hemiplegia following traumatic head and neck injury. Case one was a 22year old male who developed impaired consciousness and weakness of right upper and lower limbs 7 days after trauma. Imaging revealed an infarct in the left parieto temporal region, flow attenuation in left ICA, DSA showed left cervical ICA dissection extending upto cavernous ICA with complete cutoff at supraclinoidal ICA. Case two was a 46year old male who developed aphasia and right hemiplegia after1 week of trauma. Pilot CT revealed a SAH. Imaging after a week revealed angiogram negative anterior corpus callosal bleed with severe vasospasm and left ACA infarct.

Conclusions: Traumatic SAH and Blunt carotid artery injury can cause late onset hemiplegia in traumatic head and neck injury

Patient Care: Recommendations for screening for carotid injury: 1.GCS > 8 2.Petrous bone fracture 3.DAI 4.Lefort II and III close surveillance with ICU Care for patients with traumatic SAH and supplement with CCB like nimodipine

Learning Objectives: By the conclusion of this session, participants should be able to 1.identify the patients at risk of late onset hemiplegia 2.screening for blunt carotid artery injury

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