Be Vigilant for Blunt Cerebrovascular Injury After Trauma

Be Vigilant for Blunt Cerebrovascular Injury After Trauma

Michael D. Grossman MD

Understanding of the spectrum of blunt cerebrovascular injury has changed markedly during the past decade. In the past, these injuries were likely to be detected only after development of focal neurologic signs in patients with normal computed tomography (CT) scans of the head. Improved access to diagnostic technology and improved survival of the most severely injured trauma patients have focused attention upon earlier diagnosis and treatment of this condition.

Estimation of incidence is difficult and dependent upon specification of the population that should undergo screening, the method used to screen, sensitivity of the test, and clear agreement as to what findings constitute an injury. Published figures range between 0.1% to more than 1.0%. Incidence seems to rise as efforts at screening are intensified, suggesting the true incidence probably exceeds 1%; however, many injuries are “minimal” and their clinical consequences indeterminate.

Watch Out For

Blunt cerebrovascular injury may be caused by a variety of injury mechanisms. Relatively minor injury mechanisms may produce significant injury. Examples include hyperflexion or extension injuries of the neck producing vertebral artery occlusion and subsequent embolization into the posterior cerebral circulation. For the purposes of screening large populations of trauma patients, potential for blunt cerebrovascular injury is most often associated with severe closed head injury, cervical spine fracture (especially if the vertebral foramina are affected), skull base fractures, severe midface fractures, and presence of a “seat-belt sign” across the base of the neck. Cranial nerve findings associated with blunt force trauma to the head or neck are also suggestive of proximity to carotid and vertebral arteries.

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Jul 1, 2016 | Posted by in ANESTHESIA | Comments Off on Be Vigilant for Blunt Cerebrovascular Injury After Trauma
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