Cerebrovascular trauma

Krings, Timo; Geibprasert, Sasikhan; Lasjaunias, P.

doi:10.1007/s00330-008-0915-z

Cited by 28 publications

(9 citation statements)

References 41 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…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 majority of these injuries occur during motor vehicle accidents, with variable rates of carotid and vertebral artery involvement reported in the literature [11][12][13] .…”

mentioning

confidence: 99%

Blunt Cerebrovascular Injuries: Diagnosis and Management Outcomes

Wei

Montanera

Selchen

et al. 2010

Can. j. neurol. sci.

View full text Add to dashboard Cite

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 majority of these injuries occur during motor vehicle accidents, with variable rates of carotid and vertebral artery involvement reported in the literature [11][12][13] . If untreated, BCVI can be fatal and result in devastating neurological sequelae, with mortality and morbidity rates reported up to 38% and 67% respectively 14 .One of the difficulties in initiating treatment for BCVI is related to the variable symptomatology. While approximately ABSTRACT: Background: Blunt cerebrovascular injury (BCVI) to the carotid and vertebral arteries is a potentially devastating injury in trauma patients. The optimal management for BCVI has not been standardized. At our institution, 64-slice multi-detector computed tomographic angiography (CTA) has been used as the initial screening exam for BCVI in patients who met predefined screening criteria. The purpose of this study is to review the incidence of CTA-diagnosed BCVI in at-risk patients and to evaluate the treatment and clinical outcome of patients with BCVI. Methods: This study included trauma patients with a positive diagnosis of BCVI on CTA during a 41-month study period. The medical records and relevant radiographic findings were retrospectively reviewed. Results: Twenty seven of 222 blunt trauma patients evaluated with CTA had a positive diagnosis of BCVI, with an occurrence rate of 12.2%. Traumatic brain injury (72.2%) and basal skull fractures (55.6%) were the most frequent associated injuries with carotid trauma while 100% of blunt vertebral injuries occurred in the setting of cervical fractures. Fourteen (51.8%) patients received medical therapy; Eleven (40.7%) patients received conservative treatment. Endovascular treatment was attempted in a single case of vertebral arteriovenous fistula. BCVI-related stroke was found in four patients (14.8%), one of whom developed an infarct while on medical treatment. Conclusions: BCVI is found in a significant portion of blunt trauma patients with identifiable risk factors, and screening CTA has high diagnostic yield in detecting these lesions. Medical therapy is the mainstay of treatment at our institution; however, BCVI-related stroke may occur despite treatment. RÉSUMÉ: Diagnostic et résultats du traitement des traumatismes cérébrovasclaires contondants. Contexte :Le traumatisme cérébrovasculaire contondant (TCVC) à la carotide et aux artères vertébrales est une lésion qui peut être dévastatrice chez les patients qui ont subi un traumatisme. Le traitement optimal du TCVC n'a pas été standardisé. Dans notre institutio...

show abstract

mentioning

confidence: 99%

Blunt Cerebrovascular Injuries: Diagnosis and Management Outcomes

Wei

Montanera

Selchen

et al. 2010

Can. j. neurol. sci.

View full text Add to dashboard Cite

show abstract

“…TCI are rare diseases, which occurred in 0.18%-1.5% of all trauma patients [3] . As suggested by the blunt cerebrovascular injury practice management guidelines, trauma patients with some risk factors such as LeFort II or III fracture, seat belt abrasion, and diffuse axonal injury with GCS score < 6 et al, or some neurological signs/symptoms should receive cerebrovascular injury screening [4,5] .…”

Section: Discussionmentioning

confidence: 99%

Hyperacute Carotid Artery Occlusion with Insufficient Collateral Flow: A Case Report Illustrating a Largely Ignored Life-Threatening Traumatic Cerebrovascular Injury

Yang¹,

Tang²,

Li³

et al. 2021

Preprint

View full text Add to dashboard Cite

Background: Traumatic cerebrovascular injuries (TCI) are rare diseases, with the incidence of 0.18%-1.5% among trauma patients. Among TCI, ischemic TCI is more likely to be ignored when compared with hemorrhagic TCI. However severe ischemic TCI such as acute total occlusion of carotid artery may also be life-threatening especially when without sufficient collateral flow.Case presentation: We report an 18-year-old male patient in cardiopulmonary arrest was transported to our hospital 13 minutes after falling from a 60-feet tall building. After physical examination, an acute right internal carotid arteries (ICA) occlusion was suspected and be further confirmed by digital subtraction angiography (DSA) examination. Subsequent angiograms showed bilateral traumatic dissections of the ICA with complete occlusion of the right ICA just distal to the carotid bifurcation, and severe narrowing of the left ICA. Two covered stents were implanted to reconstruct bilateral ICAs followed by proximal occlusion of ruptured ECA branches using coils. The patient’s blood pressure gradually improved after the procedure. Dual antiplatelet therapy was initiated on the second day. Six-month Follow-up CTAs indicated that bilateral ICAs were well reconstructed, and the patient had a mRS score of 1 at six-month follow-up. Conclusion: TCI may achieve very good clinical outcome if they were diagnosed and properly treated via timely endovascular intervention.

show abstract

“…Thrombotic complications such as venous thrombosis, arterial thrombosis, and microthrombosis may occur in patients with trauma-induced hypercoagulopathy, but the location of thrombus deposition depends on the blood flow turbulence, hypercoagulable state, vascular injury site, and original pathological changes such as atherosclerosis and angionoma [11]. Venous thrombosis is more common in the femoral, internal iliac, and intermuscular veins, than in the subclavian, intracranial, portal, and splenic veins [12,13]. Particularly, venous thromboembolism (VTE) has been defined as a disease that encompasses two primary entities, deep venous thrombosis (DVT) and pulmonary embolism.…”

Section: Introductionmentioning

confidence: 99%

Chinese expert consensus on diagnosis and treatment of trauma-induced hypercoagulopathy

Song¹,

Yang²,

Zhao

et al. 2021

Military Med Res

View full text Add to dashboard Cite

Trauma-induced coagulopathy (TIC) is caused by post-traumatic tissue injury and manifests as hypercoagulability that leads to thromboembolism or hypocoagulability that leads to uncontrollable massive hemorrhage. Previous studies on TIC have mainly focused on hemorrhagic coagulopathy caused by the hypocoagulable phenotype of TIC, while recent studies have found that trauma-induced hypercoagulopathy can occur in as many as 22.2–85.1% of trauma patients, in whom it can increase the risk of thrombotic events and mortality by 2- to 4-fold. Therefore, the Chinese People’s Liberation Army Professional Committee of Critical Care Medicine and the Chinese Society of Thrombosis, Hemostasis and Critical Care, Chinese Medicine Education Association jointly formulated this Chinese Expert Consensus comprising 15 recommendations for the definition, pathophysiological mechanism, assessment, prevention, and treatment of trauma-induced hypercoagulopathy.

show abstract

Cerebrovascular trauma

Cited by 28 publications

References 41 publications

Blunt Cerebrovascular Injuries: Diagnosis and Management Outcomes

Blunt Cerebrovascular Injuries: Diagnosis and Management Outcomes

Hyperacute Carotid Artery Occlusion with Insufficient Collateral Flow: A Case Report Illustrating a Largely Ignored Life-Threatening Traumatic Cerebrovascular Injury

Chinese expert consensus on diagnosis and treatment of trauma-induced hypercoagulopathy

Contact Info

Product

Resources

About