On June 10, 2023, at 1116 eastern daylight time, a Fly Gyros LLC M24 Orion gyroplane, N49PF, was involved in an accident at the Venice Municipal Airport (VNC), Venice, Florida. The private pilot was seriously injured. The flight was conducted as a 14 Code of Federal Regulations Part 91 personal flight. A review of airport surveillance video captured the gyroplane departing runway 23. It was just above the runway in a nose-high, left bank/yaw attitude, when the spinning main rotor blades contacted the runway. The gyroplane then settled upright onto the runway, veered left, and impacted a chain link fence, resulting in substantial damage to the fuselage. There was no postimpact fire. An airport employee who responded to the accident stated that the gyroplane came to rest halfway through the fence with the engine and propeller still running. The pilot was “incoherent,” bleeding, and trying to climb out of the gyroplane. The employee and another responder turned off the engine, pulled the pilot out of the helicopter, and laid him on the ground until paramedics arrived. The pilot did not say anything to the employee about the accident. The pilot was airlifted to a local trauma hospital where law enforcement was told by the emergency room physician, “…that just before taking off they believed [the pilot] had suffered a stroke while trying to operate the gyro. They also stated [the pilot] had been dealing with a dissecting carotid artery for several weeks which may have end up causing the stroke which was confirmed by radiology testing.” According to the pilot’s wife, her husband has no memory of the accident and lost his ability to speak as a result of the stroke. As such, he was unable to provide either a verbal or written statement about the accident. However, she did tell law enforcement that she spoke with her husband just before the accident flight. He seemed normal and stated that a previous mechanical issue had been fixed, and that the gyroplane was in good condition to fly. Examination of the gyroplane by an FAA inspector revealed no mechanical issues that would have precluded normal operation of the gyroplane at the time of the accident. An NTSB Medical Officer reviewed the pilot’s medical certification and medical/hospital files to determine his medical condition at the time of the accident. According to the Medical Officer’s Factual report, the pilot did not hold an active FAA medical certification at the time of the accident and was operating under BasicMed. FAA medical certification was not required to exercise sport pilot privileges in the gyroplane, which was a light sport aircraft. When the pilot was admitted to the trauma center, he was found to have a head injury and a right anterior neck hematoma. He also was found to have left internal carotid artery dissection and embolic stroke involving brain arteries downstream of the left internal carotid artery. Hospital records indicated the pilot reportedly had been diagnosed with 70% narrowing of the left internal carotid artery in the weeks before the accident; further details were not documented. Carotid dissection may occur spontaneously (without a clearly identified trigger) or as a result of minor or major traumatic injury. Unlike carotid stenosis, carotid dissection generally is considered a non-atherosclerotic condition. Traumatic carotid dissection may be caused by vehicle accidents, particularly when there is direct blunt injury to the neck or blunt injury causing neck hyperextension and rotation. Once carotid dissection occurs, it may lead to stroke, including from embolism. The onset of stroke after carotid dissection may be rapid (within the first hour) or delayed (for example, days or weeks later). The pilot’s hospital evaluation did not definitively identify any other acute medical event affecting him at the time of the crash. The pilot did not undergo toxicological testing during his hospitalization.