Traumatic and Penetrating Head Injuries

8 penetrating TBIPenetrating Traumatic Brain Injury

“…8.2). 7 With penetrating head trauma, computed tomography an giography (CTA) of the head and neck is frequently valuable, particularly when the suspected injury is close to cervical or in tracranial vasculatures. It is considered by the American College arrow)…”

“…4 If the CTA is not obtained at the time of original imaging, recommendation for CTA or conven tional angiography should be made when there appears to be risk of injury to any major vessels. 3,[5][6][7][8] This is true when the bullet, nail, knife, umbrella, chopstick, or other object passes through or adjacent to the skull base, the carotid siphons, or any of the named intracranial vessels, including the dural ve nous sinuses. 5,6 The CTA is essential for preoperative planning before any attempted removal of an impaled object or missile.…”

“…7 In a series of 33 patients with penetrating gunshot wounds to the head, 14 demonstrated evi dence of middle cerebral artery vasospasm by transcranial Dop pler criteria (performed 0 to 33 days after injury). These find ings were also significantly associated with the presence of sub arachnoid hemorrhage on the initial head CT evaluation.…”

“…This modality is also superior to CT in the presence of metal because of the presence of streak artifact on CT. Additional indications for con ventional angiography include evidence of arterial extravasa tion and unexpected delayed hemorrhage. 7,8 ( arrowheads arrows l l Oblique coronal maximum-intensit y projection from the initial CT angiogram shows the anatomic proximity of the fracture in the planum sphenoidale to the RICA white arrow). (c) RICA injection from the catheter angiogram on admission demonstrates a narrowed and irregular supraclinoid segment of the RICA consistent with a dissection (black arrow).…”

“…In one series of 250 cases of GSW to the head from Maryland, 71% died at the scene, and the total mortality was 89%. 7 Of the patients who reach trauma centers, most have a Glasgow Coma Scale score of 8 or lower, 7 limiting physical examination and increasing the rela tive importance of diagnostic imaging.…”