Carotid and Vertebral Artery Injury following Severe Head or Cervical Spine Trauma

Abstract

In order to determine the frequency of neck vessel injuries, Doppler investigations were performed in 60 patients following either severe head injury (n = 29), cervical spine injury (n = 26), or combined head and cervical spine injury (n = 5). The majority of patients were referred to our hospital for early rehabilitation; before admission Doppler investigations had been performed in only 2 patients. Clinically, 3 patients sustained severe cerebral ischemia due to neck vessel trauma: 1 patient with left-sided ICA dissection after head trauma revealed Doppler abnormalities only in the early phase of the disease; the second patient demonstrated persistent Doppler abnormalities due to traumatic right-sided ICA and VA occlusion. The third patient sustained a fatal vertebral and basilar artery thrombosis following cervical spine injury. In 57 patients without clinical signs suspicious of neck vessel trauma, sonography revealed abnormali- ties in 3 patients (11%) with severe head injury and in 6 patients (20%) with cervical spine or combined head and spine injury, in both groups mainly related to the vertebrobasilar system. Neck vessel injury is probably an underdiagnosed complication of severe head or cervical spine trauma. Although interpretation of Doppler findings may be difficult, particularly in the vertebrobasilar system, Doppler investigations can be recommended as a screening method to exclude neck vessel injuries.

How do we Handle Traumatic Pediatric Carotid Artery Dissection?

“…Although there is cervical segment internal carotid artery dissection, there was no cervical spine fracture present either. The pathophysiology of the cervical CAD in our case is probably due to hypermobility of the neck with the head and stretching of the cervical segment of the artery [11,12].…”

Unilateral and bilateral vertebral artery dissection following motor vehicle injury—Two cases and a mini-review

“…Hence, cervical spine imaging is mandatory for identifying fractures or dislocations and ruling out concomitant instability. Angiography has traditionally been the ''gold standard'' method for the diagnosis of VAD [27]. Patients sustaining cervical spine subluxation/fracture with any lateral cervical masses should be considered for angiography [10].…”

“…Another problem arises from the wide variation of vertebral artery caliber: i.e., there is no agreement on the definition of normal vertebral artery diameter [1]. Hence, it may be difficult to differentiate long-standing VAD from vessel hypoplasia [27,36]. The incidence of VAD in cervical trauma patients varies depending on the detection method.…”

Post-traumatic cerebellar infarction due to vertebral artery foramina fracture: case report

“…(10) To detect the injury to the neck vessels Doppler can be used as a screening investigations, however it will be difficult to interpret the vertebra-basilar system. (20) In a patient with head injury now a day's computed tomography angiography (CTA) is recommended a noninvasive, highly specific, and sensitive imaging modality to rule out vascular injuries. (21) The management of post-traumatic cerebellar infarction is controversial and it is directed to reduce the intracranial pressure i.e.…”