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Blunt Cerebrovascular Injuries: Diagnosis and Management Outcomes

Published online by Cambridge University Press:  02 December 2014

Corie W. Wei ,
Walter Montanera ,
Daniel Selchen ,
Jackie Lian ,
Christopher Stevens  and
Lyne Noël de Tilly
Corie W. Wei
Affiliation:
Department of Medical Imaging, University of Toronto, Toronto, ON
Walter Montanera
Affiliation:
Department of Medical Imaging, University of Toronto, Toronto, ON
Daniel Selchen
Affiliation:
Department of Neurology, St. Michael's Hospital, University of Toronto, Toronto, ON
Jackie Lian
Affiliation:
Department of Medical Imaging, McGill University, Montreal, QC
Christopher Stevens
Affiliation:
Department of Medical Imaging, University of British Columbia, Vancouver, BC, Canada
Lyne Noël de Tilly*
Affiliation:
Department of Medical Imaging, University of Toronto, Toronto, ON
*
Department of Medical Imaging, St. Michael’s Hospital, 30 Bond Street, Toronto, Ontario, M5B 1W8, Canada.
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Abstract

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Background:

Blunt cerebrovascular injury (BCVI) to the carotid and vertebral arteries is a potentially devastating injury in trauma patients. The optimal management for BCVI has not been standardized. At our institution, 64-slice multi-detector computed tomographic angiography (CTA) has been used as the initial screening exam for BCVI in patients who met predefined screening criteria. The purpose of this study is to review the incidence of CTA-diagnosed BCVI in at-risk patients and to evaluate the treatment and clinical outcome of patients with BCVI.

Methods:

This study included trauma patients with a positive diagnosis of BCVI on CTA during a 41-month study period. The medical records and relevant radiographic findings were retrospectively reviewed.

Results:

Twenty seven of 222 blunt trauma patients evaluated with CTA had a positive diagnosis of BCVI, with an occurrence rate of 12.2%. Traumatic brain injury (72.2%) and basal skull fractures (55.6%) were the most frequent associated injuries with carotid trauma while 100% of blunt vertebral injuries occurred in the setting of cervical fractures. Fourteen (51.8%) patients received medical therapy; Eleven (40.7%) patients received conservative treatment. Endovascular treatment was attempted in a single case of vertebral arteriovenous fistula. BCVI-related stroke was found in four patients (14.8%), one of whom developed an infarct while on medical treatment.

Conclusions:

BCVI is found in a significant portion of blunt trauma patients with identifiable risk factors, and screening CTA has high diagnostic yield in detecting these lesions. Medical therapy is the mainstay of treatment at our institution; however, BCVI-related stroke may occur despite treatment.

Résumé:

RÉSUMÉ:Contexte:

Le traumatisme cérébrovasculaire contondant (TCVC) à la carotide et aux artères vertébrales est une lésion qui peut ètre dévastatrice chez les patients qui ont subi un traumatisme. Le traitement optimal du TCVC n’a pas été standardisé. Dans notre institution, l’angiographie par tomodensitométrie multibarrettes a été utilisée comme examen initial de triage pour le TCVC chez les patients qui rencontraient des critères de triage prédéterminés.

Objectif:

Le but de cette étude était de revoir l’incidence des TCVC diagnostiqués au moyen de l’AT chez les patients à risque et d’évaluer le traitement et l’issue clinique des patients qui en sont atteints.

Méthodes:

Les patients qui avaient subi un traumatisme et chez qui un diagnostic de TCVC a été posé à l’AT sur une période de 41 mois ont été inclus dans cette étude. Les dossiers des patients et les constatations radiologiques pertinentes ont été révisés rétrospectivement.

Résultats:

Vingt-sept des 222 (12,2%) patients qui avaient subi un traumatisme contondant et qui ont subi une AT, ont re9u un diagnostic de TCVC. La lésion cérébrale traumatique (72,2%) et les fractures de la base du cräne (55,6%) étaient les blessures les plus fréquentes associées au traumatisme de la carotide alors que 100% des blessures vertébrales contondantes sont survenues dans le contexte de fractures cervicales. Quatorze patients (51,8%) ont été traités médicalement et 11 patients (40,7%) ont re9u un traitement conservateur. Un traitement endovasculaire a été tenté dans un seul cas, un patient porteur d’une fistule artérioveineuse vertébrale. Quatre patients (14,8%) ont subi un accident vasculaire cérébral en relation avec le TCVC, dont un qui a subi un infarctus alors qu’il était sous traitement médical.

Conclusions:

Une proportion importante des patients qui ont subi un traumatisme contondant et qui ont des facteurs de risque identifiables ont un TCVC. L’AT est un très bon moyen diagnostique pour détecter ces lésions. Le traitement médical est le traitement de base dans notre institution. Cependant, un accident vasculaire cérébral consécutif au TCVC peut survenir malgré le traitement.

Type
Original Article
Information
Canadian Journal of Neurological Sciences , Volume 37 , Issue 5 , September 2010 , pp. 574 - 579
Copyright
Copyright © The Canadian Journal of Neurological 2010

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