Cerebrovascular injuries in traumatic brain injury

Das, Alvin S; Vicenty-Padilla, Juan C.; Chua, Melissa; Jeelani, Yasser; Snider, Samuel B.; Regenhardt, Robert W; Al‐Mufti, Fawaz; Du, Rose; Izzy, Saef

doi:10.1016/j.clineuro.2022.107479

Cited by 7 publications

(14 citation statements)

References 93 publications

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Section: Discussionmentioning

confidence: 99%

“…The Biffl scale (also referred to as the Denver scale) 33 classifies the severity of blunt cerebrovascular injury detected on neuroimaging, and it ranges from grades I to V ( table 2-2 ). The higher grades are usually associated with increased stroke risk 30 . Grade I represents a luminal irregularity or dissection with less than 25% luminal narrowing; grade II is a dissection with a raised intimal flap or vessel thrombosis, resulting in luminal narrowing greater than 25%; grade III is a dissecting aneurysm or a pseudoaneurysm; grade IV represents complete vessel occlusion or thrombosis; and grade V represents vessel transection with active extravasation or hemodynamically significant arteriovenous fistula ( table 2-2 ).…”

Section: Discussionmentioning

confidence: 99%

“…In clinical practice, patients with traumatic spinal cord injuries (mostly cervical) are at high risk of blunt cerebrovascular injury of their extracranial carotid and vertebral arteries, which is associated with an increased risk of morbidity and mortality. 30 The mechanisms of blunt cerebrovascular injury include impingement of the vessel against bone, shearing and stretching of the vessel, or laceration of the vessel by bone fragments, leading to an intimal tear. Patients with atlanto-occipital or atlantoaxial dissociation injuries, cervical spine fractures that extend through the transverse foramen, or rotational injuries such as those resulting in unilateral or bilateral jumped or perched facets are at high risk of vascular injuries.…”

Section: Key Pointsmentioning

confidence: 99%

“…30 Grade I represents a luminal irregularity or dissection with less than 25% luminal narrowing; grade II is a dissection with a raised intimal flap or vessel thrombosis, resulting in luminal narrowing greater than 25%; grade III is a dissecting aneurysm or a pseudoaneurysm; grade IV represents complete vessel occlusion or thrombosis; and grade V represents vessel transection with active extravasation or hemodynamically significant arteriovenous fistula (TABLE 2-2). 30…”

Section: Key Pointsmentioning

confidence: 99%

“…In clinical practice, low-grade (Biffl grade I and II) blunt cerebrovascular injuries (TABLE are often treated with antiplatelet or anticoagulation therapy. 30 Updated vessel imaging should be considered if the patient develops new or worsening neurologic deficits. The duration of therapy for blunt cerebrovascular injuries is also debated.…”

Section: Management Of Blunt Cerebrovascular Injurymentioning

confidence: 99%

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Traumatic Spinal Cord Injury

Izzy

2024

CONTINUUM: Lifelong Learning in Neurology

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OBJECTIVE This article provides a review of the initial clinical and radiologic evaluation and treatment of patients with traumatic spinal cord injuries. It specifically highlights essential knowledge for neurologists who encounter patients with these complex injuries. LATEST DEVELOPMENTS There has been improvement in the care of patients with traumatic spinal cord injuries, particularly in the prehospital evaluation, approach for immediate immobilization, standardized spinal clearance, efficient triage, and transportation of appropriate patients to traumatic spinal cord injury specialized centers. Advancements in spinal instrumentation have improved the surgical management of spinal fractures and the ability to manage patients with spinal mechanical instability. The clinical evidence favors performing early surgical decompression and spine stabilization within 24 hours of traumatic spinal cord injuries, regardless of the severity or location of the injury. There is no evidence that supports the use of neuroprotective treatments to improve outcomes in patients with traumatic spinal cord injuries. The administration of high-dose methylprednisolone, which is associated with significant systemic adverse effects, is strongly discouraged. Early and delayed mortality rates continue to be high in patients with traumatic spinal cord injuries, and survivors often confront substantial long-term physical and functional impairments. Whereas the exploration of neuroregenerative approaches, such as stem cell transplantation, is underway, these methods remain largely investigational. Further research is still necessary to advance the functional recovery of patients with traumatic spinal cord injuries. ESSENTIAL POINTS Traumatic spinal cord injury is a complex and devastating condition that leads to long-term neurologic deficits with profound physical, social, and vocational implications, resulting in a diminished quality of life, particularly for severely affected patients. The initial management of traumatic spinal cord injuries demands comprehensive interdisciplinary care to address the potentially catastrophic multisystem effects. Ongoing endeavors are focused on optimizing and customizing initial management approaches and developing effective therapies for neuroprotection and neuroregeneration to enhance long-term functional recovery.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Key Pointsmentioning

confidence: 99%

Section: Key Pointsmentioning

confidence: 99%

Section: Management Of Blunt Cerebrovascular Injurymentioning

confidence: 99%

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Traumatic Spinal Cord Injury

Izzy

2024

CONTINUUM: Lifelong Learning in Neurology

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Endoluminal flow diversion as a primary treatment strategy for pediatric traumatic intracranial aneurysms: a case-based review of literature

Hosseini,

Zafarshamspour,

Ghasemi-Rad

et al. 2023

Childs Nerv Syst

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Nervous System Response to Neurotrauma: A Narrative Review of Cerebrovascular and Cellular Changes After Neurotrauma

Ali,

Sula,

AbuHamdia

et al. 2024

J Mol Neurosci

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Neurotrauma is a significant cause of morbidity and mortality worldwide. For instance, traumatic brain injury (TBI) causes more than 30% of all injury-related deaths in the USA annually. The underlying cause and clinical sequela vary among cases. Patients are liable to both acute and chronic changes in the nervous system after such a type of injury. Cerebrovascular disruption has the most common and serious effect in such cases because cerebrovascular autoregulation, which is one of the main determinants of cerebral perfusion pressure, can be effaced in brain injuries even in the absence of evident vascular injury. Disruption of the blood–brain barrier regulatory function may also ensue whether due to direct injury to its structure or metabolic changes. Furthermore, the autonomic nervous system (ANS) can be affected leading to sympathetic hyperactivity in many patients. On a cellular scale, the neuroinflammatory cascade medicated by the glial cells gets triggered in response to TBI. Nevertheless, cellular and molecular reactions involved in cerebrovascular repair are not fully understood yet. Most studies were done on animals with many drawbacks in interpreting results. Therefore, future studies including human subjects are necessarily needed. This review will be of relevance to clinicians and researchers interested in understanding the underlying mechanisms in neurotrauma cases and the development of proper therapies as well as those with a general interest in the neurotrauma field.

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Cerebrovascular injuries in traumatic brain injury

Cited by 7 publications

References 93 publications

Traumatic Spinal Cord Injury

Traumatic Spinal Cord Injury

Endoluminal flow diversion as a primary treatment strategy for pediatric traumatic intracranial aneurysms: a case-based review of literature

Nervous System Response to Neurotrauma: A Narrative Review of Cerebrovascular and Cellular Changes After Neurotrauma

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