Blunt Cerebrovascular Injuries

Abstract

Cothren CC, Moore EE. Blunt cerebrovascular injuries. Clinics. 2005;60(6):489-96. Over the past decade, the recognition and subsequent management of blunt cerebrovascular injuries has undergone a marked evolution. Originally thought to be a rare occurrence, blunt cerebrovascular injuries are now diagnosed in approximately 1% of blunt trauma patients. The recognition of a clinically silent period allows for angiographic screening for injuries based upon the mechanism of trauma and the patient's constellation of injuries. Comprehensive screening of patients has resulted in the early diagnosis of blunt cerebrovascular injuries during the asymptomatic phase, thus allowing treatment that could prevent neurologic sequelae. Although the ideal regimen of antithrombotic therapy is yet to be determined, treatment with either antiplatelet or anticoagulant agents has been shown to reduce the blunt cerebrovascular injuries related stroke rate. Blunt cerebrovascular injury is a rare but potentially devastating injury; appropriate angiographic screening in high-risk patients should be performed and prompt treatment initiated to prevent ischemic neurologic events.

Pediatric blunt vertebral artery injury: case report and treatment plan

“…As this injury may be clinically silent, the true incidence of this clinical entity has been underestimated [15]. Aggressive screening in the adult population has led to an increase in diagnosis; early treatment with antithrombotic agents has nearly eliminated BCVI-related strokes [3][4][5][6][7]. A similar approach should be taken in pediatric population.…”

“…Early diagnosis and treatment with antithrombotic therapy have been proven in the adult population literature to prevent ischemic neurologic events [1][2][3][4][5][6][7][8][9]. In the pediatric literature, there are few cases of blunt cerebrovascular injuries (BCVI) reported [10][11][12][13][14].…”

Modern Advances in Vascular Trauma

“…[3][4][5][6] The frequency of diagnosis seems proportional to the aggressiveness of screening. 3,4,[7][8][9][10] Injury to the carotid and vertebral arteries is uncommon; however, when an injury occurs, poor outcomes are prevalent.…”

“…11,12 Overall, mortality is generally reported to be 20% to 30% and, for survivors, permanent neurologic impairment typically results from BCVI-related strokes. [4][5][6] A minority of BCVIs have overt signs or symptoms (Box 2) of injury. For those presenting with obvious worrisome signs or symptoms, a rapid assessment including angiography should be undertaken.…”

Cerebrovascular trauma

“…They typically involve both the cervical and petrous part of the ICA and spare the bulb [16]. The most common cause for traumatic ICA dissections are motor vehicle accidents that lead either to a hyperextension of the neck associated with contralateral lateral flexion/ rotation (with associated stretching of the ICA across the transverse processes of C2 and C3) or to an abrupt flexion of the ICA between the angle of the mandible and the upper cervical spine (leading to compression of the ICA with subsequent intimal disruption) [17]. Vertebral artery dissections can occur when the head is rotated in extension leading to stretching of the artery between C1 and C2 or when a fracture of the transverse foramen directly results in vessel wall damage [18,19].…”