Neurovascular injuries in trauma: An under recognized entity

Abstract

Blunt traumatic cerebrovascular injury (TCVI) most often go unnoticed or they get noticed only when the associated complications surface. Timely detection of blunt cerebrovascular injury significantly improves the final outcome of the patient. TCVIs can result from extreme hyperextension/rotation, direct vascular blow, intraoral trauma, or direct laceration from bony fracture fragments. The strongest predictor of a carotid artery injury is a closed head injury (Glasgow Coma Scale score </=6) while the strongest predictor of a vertebral artery injury is a cervical spine injury. CT Angiography is a useful screening tool for TCVI but Digital subtraction angiography (DSA) remains the gold standard. Endovascular treatment of TCVI is safer than surgery although the indications for treatment should be individualized.

Keywords

Traumatic-SAH - Pseudo-aneurysm - Cerebrovascular injury - Dissection - Endovascular treatment

• References

• 1 Hughes K.M., Collier B., Greene K.A., Kurek S.. Traumatic carotid artery dissection: a significant incidental finding. Am Surg 2000; 66: 1023-1027
• 2 Crissey M.M., Bernstein E.F.. Delayed presentation of carotid intimal tear following blunt craniocervical trauma. Surgery 1974; 75: 543-549
• 3 Biffl W.L., Moore E.E., Offner P.J.. et al Optimizing screening for blunt cerebrovascular injuries. Am J Surg 1999; 178: 517-522
• 4 Lew S.M., Frumiento C., Wald S.L.. Pediatric blunt carotid injury: a review of the National Pediatric Trauma Registry. Pediatr Neurosurg 1999; 30: 239-244
• 5 DuBose J., Recinos G., Teixeira P.G., Inaba K., Demetriades D.. Endovascular stenting for the treatment of traumatic internal carotid injuries: expanding experience. J Trauma 2008; 65: 1561-1566
• 6 Miller P.R., Fabian T.C., Bee T.K.. et al Blunt cerebrovascular injuries: diagnosis and treatment. J Trauma 2001; 51: 279-285 discussion 285–286
• 7 Miller P.R., Fabian T.C., Croce M.A.. et al Prospective screening for blunt cerebrovascular injuries: analysis of diagnostic modalities and outcomes. Ann Surg 2002; 236: 386-393 discussion 393–395
• 8 Schulte S., Donas K.P., Pitoulias G.A., Horsch S.. Endovascular treatment of iatrogenic and traumatic carotid artery dissection. Cardiovasc Intervent Radiol 2008; 31: 870-874
• 9 Kadkhodayan Y., Jeck D.T., Moran C.J., Derdeyn C.P., Cross III D.T.. Angioplasty and stenting in carotid dissection with or without associated pseudoaneurysm. AJNR Am J Neuroradiol 2005; 26: 2328-2335
• 10 Attigah N., Kulkens S., Zausig N.. et al Surgical therapy of extracranial carotid artery aneurysms: long-term results over a 24-year period. Eur J Vasc Endovasc Surg 2009; 37: 127-133
• 11 Engelter S.T., Brandt T., Debette S.. et al Antiplatelets versus anticoagulation in cervical artery dissection. Stroke 2007; 38: 2605-2611
• 12 Benoit B.G., Wortzman G.. Traumatic cerebral aneurysms. Clinical features and natural history. J Neurol Neurosurg Psychiatry 1973; 36: 127-138