Abstract:574In recent years, blunt cerebrovascular injury (BCVI) is gaining attention as an important sequela of nonpenetrating trauma to the neck and skull base. Blunt cerebrovascular injury affects approximately 1% of all blunt trauma admissions, and the reported incidence is as high as 2.7% in centres with aggressive screening protocols [1][2][3][4][5][6][7][8] . The pattern of BCVI consists of vascular transection, dissection, thrombosis, and formation of pseudoaneurysm or arteriovenous fistula (AVF) 9,10 . The maj… Show more
“…15 Multidetector CT continues to improve in accuracy and currently its ability to assess VAI lies somewhere between catheter angiography and TOF MRA. 16 Many previous studies have examined VAI in the context of acute or subacute trauma. A single study 4 looked at follow-up imaging and noted recanalisation in previously occluded arteries.…”
Study design: Prospective study. Objective: To ascertain the prevalence of posterior circulation stroke in traumatic chronic spinal cord injured (SCI) patients and associated traumatic vertebral artery injuries (VAI). Methods: All adult patients with cervical SCI and American Spinal Injury Association Impairment Scale (AIS) grade A or B referred for follow-up magnetic resonance imaging of their spinal cord were invited to take part in the study between January 2010 and December 2012 at the National Spinal Injury Centre. Two additional sequences were added to the existing imaging protocol to evaluate the brain and vertebral arteries. Results: Ninety-eight patients were recruited. All imaging were analysed independently by three consultant radiologists. Posterior circulation infarcts were noted in seven (7%) patients. Significant VAI was noted in 13 patients (13%) with 10 occlusions and 3 with high-grade stenosis. However, only one patient had co-existent posterior circulation infarct and significant VAI. Conclusion: There is an increased prevalence of posterior circulation infarction in SCI patients. The relationship with associated traumatic VAI requires further investigation.
“…15 Multidetector CT continues to improve in accuracy and currently its ability to assess VAI lies somewhere between catheter angiography and TOF MRA. 16 Many previous studies have examined VAI in the context of acute or subacute trauma. A single study 4 looked at follow-up imaging and noted recanalisation in previously occluded arteries.…”
Study design: Prospective study. Objective: To ascertain the prevalence of posterior circulation stroke in traumatic chronic spinal cord injured (SCI) patients and associated traumatic vertebral artery injuries (VAI). Methods: All adult patients with cervical SCI and American Spinal Injury Association Impairment Scale (AIS) grade A or B referred for follow-up magnetic resonance imaging of their spinal cord were invited to take part in the study between January 2010 and December 2012 at the National Spinal Injury Centre. Two additional sequences were added to the existing imaging protocol to evaluate the brain and vertebral arteries. Results: Ninety-eight patients were recruited. All imaging were analysed independently by three consultant radiologists. Posterior circulation infarcts were noted in seven (7%) patients. Significant VAI was noted in 13 patients (13%) with 10 occlusions and 3 with high-grade stenosis. However, only one patient had co-existent posterior circulation infarct and significant VAI. Conclusion: There is an increased prevalence of posterior circulation infarction in SCI patients. The relationship with associated traumatic VAI requires further investigation.
“…Injuries involving traumatic rotation of the cervical vertebrae include atlantoaxial rotatory fixation (presenting with an inability to return the head to anatomical baseline), traumatic isolation of the articular pillar, and unilateral dislocation [23]. Severe injuries of this nature demonstrate a rotation of C1-C2 of greater than 45 degrees, or a widening of the atlanto-dens interval of greater than 3 mm [24]. In some blunt traumas involving rotational forces, these signs may be absent if a portion of the force is translated into a fracture of the vertebrae; thus, less displacement can be expected if an articular mass fracture is present.…”
Section: Pathophysiology Of Traumatic Vaimentioning
confidence: 99%
“…Endovascular treatment methods may be employed when antiplatelet or anticoagulation methods are contraindicated [11,24,33]. Endovascular treatment of spontaneous VA dissections has been extensively studied, but not so in traumatic injuries.…”
Section: Classification and Treatment Of Traumatic Vaimentioning
confidence: 99%
“…The natural history of traumatic VAI is that over 90% of stenotic dissections resolve within several months and over half of occluded vessels recanalize [24,26]. This trend toward spontaneous vessel healing has promoted a culture of conservative management of traumatic VAIs in the acute setting, as opposed to aggressive surgical correction.…”
Section: Classification and Treatment Of Traumatic Vaimentioning
“…4,12 For example, even in patients aggressively screened for injury, approximately 25% to 40% have a concomitant hemorrhagic injury that has traditionally been considered a contraindication to therapy. 4,12,20 These competing injuries typically include TBIs and spinal cord injury (SCI) or traumatic neurologic injuries (TNI).…”
Section: Modern Advances In Vascular Traumamentioning
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