27-year-old woman, 27 weeks pregnant, wearing a seat belt, driver, who had a head-on collision with another vehicle during an overtaking manoeuvre, presented with cranioencephalic trauma with loss of consciousness.
In the emergency department she presented with a Glasgow Coma Scale score of 15; 90 minutes after the accident she developed dysarthria and aphasia, with no obstetric involvement.
She was admitted to the ICU 2h 15min after the accident, with motor aphasia, right proximal hemiplegia and right extensor plantar cutaneous reflex, cutaneous mark of the seat belt in the abdominal area and in the left lateral cervical region. A cranial CT scan and an extracranial Doppler ultrasound were performed without pathological findings. At 18h, a cranial magnetic resonance imaging (MRI) of the cervical spine and an angio-MRI of the supra-aortic trunks and intracranial vessels were performed, These showed an acute infarction in the territory of the left middle cerebral artery affecting the corpus striatum and the left frontoparietal corticosubcortical region, as well as a diffuse decrease in the calibre of the left ICA with severe stenosis of the C6-C7 supraclinoid segment, secondary to arterial dissection. Platelet antiplatelet therapy was started with 200mg of ASA. Subsequently a dead foetus was detected by ultrasound; a caesarean section was performed 24h later.

At hospital discharge, 2 weeks after the accident, she presented with minimal predominantly motor dysphasia, and 3/5 proximal hemiparesis in the right upper extremity and 0/5 distal hemiparesis in the right lower extremity.