Cervical vessel injury after blunt trauma

Abstract

Blunt trauma accounts for 3% to 10% of cervical vessel injuries. Death and severe neurologic impairment have been reported in more than 80% of blunt carotid injuries. In our recent experience, 10 patients sustained 18 blunt cervical arterial injuries: two internal carotid artery (ICA) dissections, three ICA transections with pseudoaneurysm, five ICA thromboses, two vertebral artery dissections, one vertebral artery transection with pseudoaneurysm, one vertebral artery thrombosis, one minimal vertebral artery injury, and three caroticocavernous fistulas. A delay of more than 12 hours in making the diagnosis occurred in seven of the 10 patients. The mental status was initially normal in seven patients. The subsequent development of focal neurologic findings incongruent with CT scanning of the head prompted four-vessel angiography. Treatment was individualized and included supportive management, intravenous heparin, ligation, extracranial-intracranial bypass, and radiologic embolization. We have developed an angiographic classification that may aid management. Early angiography in patients with neurologic findings incongruent with head CT scan or in whom a normal sensorium and hemiparesis are present may permit improved outcomes. We advocate direct operative repair for accessible lesions of recent onset. For surgically inaccessible lesions, those with delayed presentation or in some cases with a fixed neurologic deficit, intravenous heparin can be started and follow-up angiography, head CT scanning, and the patient's clinical status determine further therapy.

Pediatric Blunt Carotid Injury: A Review of the National Pediatric Trauma Registry

“…Theoretically, timely treatment may prevent progression to frank dissection, formation of a pseudoaneurysm, or thrombosis, thus avoiding secondary neurologic deficits. Accordingly, several reports have shown that outcome correlates with neurological status at diagnosis [4, 12, 13, 14, 15]. A variety of clinical signs and symptoms should raise suspicion for BCI, including: direct evidence of lateral neck trauma, ipsilateral Horner syndrome from injury to nearby sympathetic nerves, transient ischemic attacks, lucid intervals followed by neurologic deterioration, and any focal deficit unexplained by computed tomographic scans of the head or detected spine trauma.…”

Blunt traumatic disruption of the vertebral artery treated by GD coiling

“…15 Following initiation of a screening programme for blunt carotid and vertebral artery injuries, 4 Biffl et al found that their incidence of blunt cervical vessel injuries increased from 0.1 to 1.1% of all blunt trauma admission. This series did not separate clearly carotid and vertebral artery injuries, however in a multivariate analysis of their findings, the only independent predictor of blunt vertebral artery injury was cervical spine fracture.…”

“…The incidence of this type of vascular finding is unknown and it Vertebral artery injuries have been reported previously in the literature. 7,8,13,15,[17][18][19][20][21][22]31,36,38,43 The vertebral arteries originate from the subclavian arteries and enter the foramen transversarium at the level of the sixth cervical vertebra. It leaves the foramen transversarium at the second cervical vertebra and ascends superiorly to merge with the contralateral vessel and form the basilar artery.…”

Evaluation and Management for Carotid Dissection in Patients Presenting After Choking or Strangulation

“…The incidence of blunt carotid injury is reported to be around one to two per 1000 blunt injuries and accounts for only 1.5-10% of all reported carotid injuries (2)(3)(4)(5)(6). These injuries can be devastating, with mortality rates reported between 20% and 40%, and permanent neurological disabilities occurring in 40 -80% of survivors (4,7,8). One of the recurrent issues with CD is that the patient often does not present or the diagnosis is not entertained until there are neurological deficits present.…”