Mechanism of blunt cerebrovascular injury

(A) Cervical hyperextension stretches the internal carotid artery across the lateral articular processes of the first through third cervical vertebrae, causing intimal tearing.
(B) Cervical hyperflexion may directly compress the internal carotid artery between the mandible and the upper cervical vertebrae, causing intimal disruption or mural hematoma.
(C) Falling with a hard object in the mouth (eg, toothbrush) can lead to injury of the internal carotid artery at the angle of the jaw.