Blunt Cerebrovascular Injuries: Advances in Screening, Imaging, and Management Trends

Overview

Journal AJNR Am J Neuroradiol

Specialty Neurology

Date 2017 Oct 14

PMID 29025722

Citations 24

Authors

P Nagpal

B A Policeni

G Bathla

A Khandelwal

C Derdeyn

D Skeete

Affiliations

Soon will be listed here.

Abstract

Blunt cerebrovascular injury is a relatively uncommon but sometimes life-threatening injury, particularly in patients presenting with ischemic symptoms in that vascular territory. The decision to pursue vascular imaging (generally CT angiography) is based on clinical and imaging findings. Several grading scales or screening criteria have been developed to guide the decision to pursue vascular imaging, as well as to recommend different treatment options for various injuries. The data supporting many of these guidelines and options are limited however. The purpose of this article is to review and compare these scales and criteria and the data supporting clinical efficacy and to make recommendations for future research in this area.

Citing Articles

Vascular Imaging is the Only Reliable Method to Exclude Blunt Cerebrovascular Injury Post Hanging or Strangulation.

Khan M, Wain H, Khan A, Clarke D World J Surg. 2025; 49(3):752-756.

PMID: 39904936 PMC: 11903248. DOI: 10.1002/wjs.12501.

[Which diagnostic tests are indicated in the emergency department after trauma to the cervical spine?].

Riesenbeck O, Raschke M Unfallchirurgie (Heidelb). 2025; 128(2):75-80.

PMID: 39760888 DOI: 10.1007/s00113-024-01520-3.

Successful surgical intervention in traumatic carotid artery thrombosis after a motor vehicle accident: a case report.

Yigit G J Trauma Inj. 2024; 36(1):49-52.

PMID: 39381669 PMC: 11309214. DOI: 10.20408/jti.2021.0095.

Imaging of cerebrovascular complications from blunt skull base trauma.

Bai J, Ismail R, Kessler A, Kawakyu-OConnor D Emerg Radiol. 2024; 31(4):529-542.

PMID: 38806851 PMC: 11289000. DOI: 10.1007/s10140-024-02243-z.

Shifting Perspectives: Equal Blunt Cerebrovascular Risk in Low-Versus High-Energy Cervical Fracture.

Turaczyk Kolodziej D, Lung M, Lilienthal M, Galet C, Mani V, Skeete D J Surg Res. 2024; 300:63-70.

PMID: 38795674 PMC: 11246807. DOI: 10.1016/j.jss.2024.04.058.

References

Hunter M, Santosh C, Teasdale E, Forbes K . High-resolution double inversion recovery black-blood imaging of cervical artery dissection using 3T MR imaging. AJNR Am J Neuroradiol. 2011; 33(11):E133-7. PMC: 7965578. DOI: 10.3174/ajnr.A2599. View

Wu X, Malhotra A, Forman H, Nunez D, Sanelli P . The Use of High-Risk Criteria in Screening Patients for Blunt Cerebrovascular Injury: A Survey. Acad Radiol. 2016; 24(4):456-461. DOI: 10.1016/j.acra.2016.11.010. View

Biffl W, Moore E, Offner P, Brega K, Franciose R, Burch J . Blunt carotid arterial injuries: implications of a new grading scale. J Trauma. 1999; 47(5):845-53. DOI: 10.1097/00005373-199911000-00004. View

Schneidereit N, Simons R, Nicolaou S, Graeb D, Brown D, Kirkpatrick A . Utility of screening for blunt vascular neck injuries with computed tomographic angiography. J Trauma. 2006; 60(1):209-15. DOI: 10.1097/01.ta.0000195651.60080.2c. View

Sliker C . Blunt cerebrovascular injuries: imaging with multidetector CT angiography. Radiographics. 2008; 28(6):1689-708. DOI: 10.1148/rg.286085521. View

Buch K, Nguyen T, Mahoney E, Libby B, Calner P, Burke P . Association between cervical spine and skull-base fractures and blunt cerebrovascular injury. Eur Radiol. 2015; 26(2):524-31. DOI: 10.1007/s00330-015-3858-1. View

Berne J, Reuland K, Villarreal D, McGovern T, Rowe S, Norwood S . Sixteen-slice multi-detector computed tomographic angiography improves the accuracy of screening for blunt cerebrovascular injury. J Trauma. 2006; 60(6):1204-9. DOI: 10.1097/01.ta.0000220435.55791.ce. View

Debette S, Leys D . Cervical-artery dissections: predisposing factors, diagnosis, and outcome. Lancet Neurol. 2009; 8(7):668-78. DOI: 10.1016/S1474-4422(09)70084-5. View

Nace S, Gentry L . Cerebrovascular trauma. Neuroimaging Clin N Am. 2014; 24(3):487-511, viii. DOI: 10.1016/j.nic.2014.03.006. View

10.

Moar J . Traumatic rupture of the cervical carotid arteries: an autopsy and histopathological study of 200 cases. Forensic Sci Int. 1987; 34(4):227-44. DOI: 10.1016/0379-0738(87)90036-3. View

11.

Cothren C, Biffl W, Moore E, Kashuk J, Johnson J . Treatment for blunt cerebrovascular injuries: equivalence of anticoagulation and antiplatelet agents. Arch Surg. 2009; 144(7):685-90. DOI: 10.1001/archsurg.2009.111. View

12.

Nagpal P, Khandelwal A, Saboo S, Bathla G, Steigner M, Rybicki F . Modern imaging techniques: applications in the management of acute aortic pathologies. Postgrad Med J. 2015; 91(1078):449-62. DOI: 10.1136/postgradmedj-2014-133178. View

13.

Bromberg W, Collier B, Diebel L, Dwyer K, Holevar M, Jacobs D . Blunt cerebrovascular injury practice management guidelines: the Eastern Association for the Surgery of Trauma. J Trauma. 2010; 68(2):471-7. DOI: 10.1097/TA.0b013e3181cb43da. View

14.

Biffl W, Ray Jr C, Moore E, Franciose R, Aly S, Heyrosa M . Treatment-related outcomes from blunt cerebrovascular injuries: importance of routine follow-up arteriography. Ann Surg. 2002; 235(5):699-706; discussion 706-7. PMC: 1422496. DOI: 10.1097/00000658-200205000-00012. View

15.

Sakurai K, Miura T, Sagisaka T, Hattori M, Matsukawa N, Mase M . Evaluation of luminal and vessel wall abnormalities in subacute and other stages of intracranial vertebrobasilar artery dissections using the volume isotropic turbo-spin-echo acquisition (VISTA) sequence: a preliminary study. J Neuroradiol. 2012; 40(1):19-28. DOI: 10.1016/j.neurad.2012.02.005. View

16.

Ravindra V, Bollo R, Sivakumar W, Akbari H, Naftel R, Limbrick Jr D . Predicting Blunt Cerebrovascular Injury in Pediatric Trauma: Validation of the "Utah Score". J Neurotrauma. 2016; 34(2):391-399. PMC: 5220560. DOI: 10.1089/neu.2016.4415. View

17.

Mutze S, Rademacher G, Matthes G, Hosten N, Stengel D . Blunt cerebrovascular injury in patients with blunt multiple trauma: diagnostic accuracy of duplex Doppler US and early CT angiography. Radiology. 2005; 237(3):884-92. DOI: 10.1148/radiol.2373042189. View

18.

Biffl W, Moore E, Offner P, Burch J . Blunt carotid and vertebral arterial injuries. World J Surg. 2001; 25(8):1036-43. DOI: 10.1007/s00268-001-0056-x. View

19.

Davis J, Holbrook T, Hoyt D, Mackersie R, Field Jr T, Shackford S . Blunt carotid artery dissection: incidence, associated injuries, screening, and treatment. J Trauma. 1990; 30(12):1514-7. View

20.

Cothren C, Moore E, Ray Jr C, Johnson J, Moore J, Burch J . Cervical spine fracture patterns mandating screening to rule out blunt cerebrovascular injury. Surgery. 2006; 141(1):76-82. DOI: 10.1016/j.surg.2006.04.005. View