Helical Computed Tomographic Angiography: An Excellent Screening Test for Blunt Cerebrovascular Injury

Berne, John D.; Norwood, Scott H.; McAuley, Clyde E.; Villareal, David H.

doi:10.1097/01.ta.0000135499.70048.c7

Cited by 119 publications

(77 citation statements)

References 19 publications

(42 reference statements)

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“…These data are supported by the work of Biffl et al 17 and Berne and coworkers. 31 Neither group reported delayed neurologic complications of BCVI in patients with normal results on CTA. The incidence of BCVI in our study is at the upper end of the range published in the literature.…”

Section: Discussionmentioning

confidence: 99%

Whole body CT trauma imaging with adapted and optimized CT- angiography of the cranio-cervical vessels: do we need an extra screening examination?

Langner¹,

Fleck²,

Kirsch³

et al. 2008

Fortschr Röntgenstr

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Section: Discussionmentioning

confidence: 99%

Whole body CT trauma imaging with adapted and optimized CT- angiography of the cranio-cervical vessels: do we need an extra screening examination?

Langner¹,

Fleck²,

Kirsch³

et al. 2008

Fortschr Röntgenstr

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“…1,4,5 When asymptomatic patients are screened for blunt cerebrovascular injuries, the incidence rate rises to 1% of all blunt trauma patients and as high as 2.7% in patients with an Injury Severity Score greater than 16. 6,7 The possibility of association with cerebrovascular injury rises up to 17.2% to 25.5% in "high-risk" patients who satisfy the Denver screening criteria for blunt cerebrovascular injury.…”

Section: Discussionmentioning

confidence: 99%

“…1 The frequency of vertebrobasilar ischemia in patients with cervical spine trauma is reported as low in many published papers, but there have been some case reports describing cervical spine injury associated with blunt VA injury. Many aspects of the management of VA injuries remain controversial, including the screening criteria, the diagnostic modality, and the optimal treatment for various lesions.…”

Section: Introductionmentioning

confidence: 99%

“…Recent improvements in the imaging technology and increased use of screening protocols have led to a greater number of these injuries being identified. 1 Traumatic VA injury can have disastrous consequences of basilar territory infarction and death. 2 Although it is often assumed that reduction of a fracture without treatment of an associated asymptomatic VA injury is safe, 3 when vertebrobasilar ischemia occurs, the mortality rate is 75% to 86%.…”

Section: Introductionmentioning

confidence: 99%

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Distal Embolic Brain Infarction Due to Recanalization of Asymptomatic Vertebral Artery Occlusion Resulting From Cervical Spine Injury: A Case Report

Nakao

Terai

2014

Journal of Chiropractic Medicine

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Objective: The purpose of this case report is to describe a patient with brain infarction due to recanalization of an occluded vertebral artery (VA) following closed reduction and open fixation of cervical spinal dislocation and to discuss the management of asymptomatic VA injuries associated with spine trauma. Clinical Features: A 41-year-old Asian man experienced a C4-5 distractive-flexion injury manifesting with quadriplegia and anesthesia below the C3 cord level (including phrenic nerve paralysis), and bowel and bladder dysfunction. Magnetic resonance angiography and computed tomography angiography showed left extracranial VA (V2) occlusion and a patent contralateral VA. Intervention and Outcome: The patient was observed without antiplatelet and/or anticoagulation therapy and underwent open reduction and internal fusion of C4/5 and tracheostomy 8 hours after the injury. After surgery, supraspinal symptoms such as left horizontal nystagmus and left homonymous hemianopsia led to cranial computed tomography and magnetic resonance imaging, which showed left-side cerebellar infarction in the posterior inferior cerebellar artery territory and right-side posterior cerebral artery infarction. Magnetic resonance angiography and computed tomography angiography demonstrated patent bilateral VA (but hypoplastic right VA) and occluded right posterior cerebral artery. The injured VA was treated conservatively, and there were no other ischemic complications. Conclusion: The management of asymptomatic VA injury is controversial, with several treatment options available, including observation alone, antiplatelet therapy, anticoagulation therapy, or invasive intervention. Although there are some reports described where management with observation alone seems safe, serious attention should be given to the VA injury caused by cervical spine trauma.

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“…Although the CTA is an adequate screening procedure for BCVI, its specificity and sensitivity is still lower compared to the conventional angiography without the possibility of primary endovascular stenting [1,18]. Low-grade injuries like Grade 1 lesions, which cause strokes in 7% of cases and can progress to higher-grade injuries in 9% are missed more often in CTA [9].…”

Section: C1 Fracturementioning

confidence: 99%

Blunt cerebrovascular injuries in acute trauma care: a screening protocol

et al. 2011

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Introduction Blunt cerebrovascular injuries (BCVI) of the extra-or intracerebral vessels are frequently observed lesions which may lead to thrombembolic events with focal neurological deficits, stroke or death particularly in patients \60 years. However, a comprehensive standardised clinical algorithm for screening and management of these secondary injuries is still lacking. Materials and methods We developed a standardised screening protocol applicable for mild as well as severely injured patients. In this prospective cohort study, we evaluated the feasibility of this diagnostic algorithm in a level 1 trauma centre setting. Trauma patients who met the inclusion criteria underwent a computed tomographic angiography (CTA) as part of standard diagnostic procedure at admission. All suspicions or positive findings were reevaluated by a conventional four-vessel catheter angiography within the first 72 h after trauma. Within this period, anticoagulation with low-dose heparin was started. BCVI confirmation indicated a shift to systemic heparinisation with overlapping phenprocoumon therapy for at least 6 months. All patients were reevaluated after 6 months by another four-vessel angiography. Depending on the diagnostic findings, oral anticoagulation may be discontinued or continued for another 6 months.Results A total of 44 patients (8 male, 6 female, age range 19-95 years) were included in the study. 20 BCVIs were detected in 16 patients (36.3%). The most common injuries identified were Biffl Type II (40%) and Type IV lesions (30%). 86.4% of the patients received a CTA upon admission, 93.2% of which were conducted within 12 h posttrauma. None of the patients had a secondary thrombembolic neurological event during the hospital stay or within 3 months postdischarge. Conclusion Our results indicate that implementation of the screening protocol can prevent strokes in patients without primary thrombembolic neurological deficits.

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Helical Computed Tomographic Angiography: An Excellent Screening Test for Blunt Cerebrovascular Injury

Abstract: CTA is an excellent test with which to screen for BCVI.

Cited by 119 publications

References 19 publications

Whole body CT trauma imaging with adapted and optimized CT- angiography of the cranio-cervical vessels: do we need an extra screening examination?

Whole body CT trauma imaging with adapted and optimized CT- angiography of the cranio-cervical vessels: do we need an extra screening examination?

Distal Embolic Brain Infarction Due to Recanalization of Asymptomatic Vertebral Artery Occlusion Resulting From Cervical Spine Injury: A Case Report

Blunt cerebrovascular injuries in acute trauma care: a screening protocol

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