Blunt Cerebrovascular Injuries: Advances in Screening, Imaging, and Management Trends

Nagpal, Prashant; Policeni, Bruno; Bathla, Girish; Khandelwal, Ashish; Derdeyn, Colin P.; Skeete, Dionne

doi:10.3174/ajnr.a5412

Cited by 63 publications

(68 citation statements)

References 52 publications

(98 reference statements)

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Though the technique may offer comparable sensitivity and specificity as that of CTA it remains impractical and time consuming as a screening tool for the multi-traumatized patient. Ultrasound is observer-dependent and visualizing the entire vertebral artery is challenging [ 66 ].…”

Section: Resultsmentioning

confidence: 99%

Best practice guidelines for blunt cerebrovascular injury (BCVI)

Brommeland

Helseth

Aarhus

et al. 2018

Scand J Trauma Resusc Emerg Med

104

126

View full text Add to dashboard Cite

Blunt cerebrovascular injury (BCVI) is a non-penetrating injury to the carotid and/or vertebral artery that may cause stroke in trauma patients. Historically BCVI has been considered rare but more recent publications indicate an overall incidence of 1–2% in the in-hospital trauma population and as high as 9% in patients with severe head injury. The indications for screening, treatment and follow-up of these patients have been controversial for years with few clear recommendations. In an attempt to provide a clinically oriented guideline for the handling of BCVI patients a working committee was created. The current guideline is the end result of this committees work. It is based on a systematic literature search and critical review of all available publications in addition to a standardized consensus process. We recommend using the expanded Denver screening criteria and CT angiography (CTA) for the detection of BCVI. Early antithrombotic treatment should be commenced as soon as considered safe and continued for at least 3 months. A CTA at 7 days to confirm or discard the diagnosis as well as a final imaging control at 3 months should be performed.Electronic supplementary materialThe online version of this article (10.1186/s13049-018-0559-1) contains supplementary material, which is available to authorized users.

show abstract

Section: Resultsmentioning

confidence: 99%

Best practice guidelines for blunt cerebrovascular injury (BCVI)

Brommeland

Helseth

Aarhus

et al. 2018

Scand J Trauma Resusc Emerg Med

104

126

View full text Add to dashboard Cite

show abstract

“…External segments are susceptible to being stretched over the lateral masses of the cervical vertebrae (particularly the C1–3 vertebrae). 16,17) Other etiologies were a direct blow to the anteromedial neck 12) and direct intraoral trauma. 18) Blunt vertebral injuries commonly occurred in the atlantal part (V2 segment) or foraminal part (V3 segment) as a result of laceration from fracture fragments or stretching.…”

Section: Discussionmentioning

confidence: 99%

“…The Modified Denver Criteria are the most studied and commonly used. 16) If BCVI is suspected, screening using 16-section or higher CT scanners is recommended. 22) MRA is also helpful in diagnosing arterial dissections.…”

Section: Discussionmentioning

confidence: 99%

Bilateral Internal Carotid and Left Vertebral Artery Dissection after Blunt Trauma: A Case Report and Literature Review

Ariyada

Shibahashi

Hoda

et al. 2019

Neurol. Med. Chir.(Tokyo)

View full text Add to dashboard Cite

Multi-vessel cervical arterial injury after blunt trauma is rare, and its pathophysiology is unclear. Although blunt cerebrovascular injury is a common cause of cerebral ischemia, its management is still controversial. We describe a 23-year-old man in previously good health who developed three-vessel cervical arterial dissections due to blunt trauma. He was admitted to our emergency and critical care center after a motor vehicle crash. Computed tomography showed a thin, acute subdural hematoma in the right hemisphere and fractures of the odontoid process (Anderson type III), pelvis, and extremities. He was treated conservatively, and about 1 month later, he developed bleariness. Computed tomography angiography showed bilateral internal carotid and left vertebral artery dissection. Aspirin therapy was started immediately, and then clopidogrel was added to the regimen. Two weeks later, magnetic resonance angiography (MRA) showed improved blood flow of the vessels. Only aspirin therapy was continued. About 3 months after discharge, MRA demonstrated further improvement of the blood flow of both internal carotid arteries, but the dissection flap on the right side remained. Therefore, we extended the duration of antiplatelet therapy. On the basis of our experience with this case, we think that antithrombotic therapy is crucial for the management of multi-vessel cervical arterial injury, and agents should be used properly according to the injury grade and phase; however, further study is needed to confirm this recommendation.

show abstract

“…Stroke is the most feared complication of VAI and reported in 10-13% of patients. Therefore, early screening in patients with VAI may decrease the incidence of stroke 18 . Even in cases where antiplatelet agents may be contra-indicated due to concomitant injuries, the advantages of screening for BCVI at the time of presentation aids planning for the treatment, close follow-up, and possible preventing delayed presentation with ischaemic posterior circulation events.…”

Section: Discussionmentioning

confidence: 99%

Vertebral artery injury in major trauma patients in Saudi Arabia: A retrospective cohort study

Chowdhury

Almubarak

Binsaad

et al. 2020

Sci Rep

View full text Add to dashboard Cite

Blunt vertebral artery injury (VAI) is associated with severe cervicocephalic trauma and may have devastating consequences. This study aimed to determine the incidence and nature of VAI in polytrauma patients. The secondary objective was to assess the association of VAI with previously suggested risk factors. It was a retrospective observational study of all polytrauma patients admitted to the trauma unit between April 2018 and July 2019, who had CT neck angiography to diagnose blunt VAI according to modified Denver criteria. Out of 1084 admitted polytrauma patients, 1025 (94.6%) sustained blunt trauma. Of these, 120 (11.7%) underwent screening CT neck angiography. VAI was detected in 10 (8.3%; 95% CI 4.1–14.8) patients. There were three patients with Grade I injury, two with Grade II, and five with Grade IV injury. Among all trauma admissions, the incidence of diagnosed VAI was 0.9% (95% CI 0.5–1.8). Among patients suspected of VAI, there was no univariable association of VAI with C-Spine fracture: OR 4.2 (95% CI 0.51–34.4; p = 0.18). There were two (20%) deaths related to VAI. Traumatic VAI was uncommonly detected in this major trauma service in Saudi Arabia. High suspicion and liberal screening by CT angiography in cases where VAI is possible should be considered to avoid missed injuries.

show abstract

Blunt Cerebrovascular Injuries: Advances in Screening, Imaging, and Management Trends

Cited by 63 publications

References 52 publications

Best practice guidelines for blunt cerebrovascular injury (BCVI)

Best practice guidelines for blunt cerebrovascular injury (BCVI)

Bilateral Internal Carotid and Left Vertebral Artery Dissection after Blunt Trauma: A Case Report and Literature Review

Vertebral artery injury in major trauma patients in Saudi Arabia: A retrospective cohort study

Contact Info

Product

Resources

About