Blunt cerebrovascular injuries in severe traumatic brain injury: incidence, risk factors, and evolution

Abstract

OBJECTIVE Blunt cerebrovascular injuries (BCVIs) affect approximately 1% of patients with blunt trauma. An antithrombotic or anticoagulation therapy is recommended to prevent the occurrence or recurrence of neurovascular events. This treatment has to be carefully considered after severe traumatic brain injury (TBI), due to the risk of intracranial hemorrhage expansion. Thus, the physician in charge of the patient is confronted with a hemorrhagic and ischemic risk. The main objective of this study was to determine the incidence of BCVI after severe TBI. METHODS The authors conducted a prospective, observational, single-center study including all patients with severe TBI admitted in the trauma center. Diagnosis of BCVI was performed using a 64-channel multidetector CT. Characteristics of the patients, CT scan results, and outcomes were collected. A multivariate logistic regression model was developed to determine the risk factors of BCVI. Patients in whom BCVI was diagnosed were treated with systemic anticoagulation. RESULTS In total, 228 patients with severe TBI who were treated over a period of 7 years were included. The incidence of BCVI was 9.2%. The main risk factors were as follows: motorcycle crash (OR 8.2, 95% CI 1.9-34.8), fracture involving the carotid canal (OR 11.7, 95% CI 1.7-80.9), cervical spine injury (OR 13.5, 95% CI 3.1-59.4), thoracic trauma (OR 7.3, 95% CI 1.1-51.2), and hepatic lesion (OR 13.3, 95% CI 2.1-84.5). Among survivors, 82% of patients with BCVI received systemic anticoagulation therapy, beginning at a median of Day 1.5. The overall stroke rate was 19%. One patient had an intracranial hemorrhagic complication. CONCLUSIONS Blunt cerebrovascular injuries are frequent after severe TBI (incidence 9.2%). The main risk factors are high-velocity lesions and injuries near cervical arteries.

Clinical profile and comorbidity of traumatic brain injury among younger and older men and women: a brief research notes

“…Similarly, in a population-based study by Macciocchi and colleagues, 60% of patients with a traumatic spinal cord injury had a co-occurring TBI [24]. Paraplegic patients with severe TBI had lower FIM™ motor scores and a longer LOS in rehabilitation, compared to those without TBI or mild TBI [25]. Additional injury to the peripheral nerves occurs in approximately 34% of patients with severe TBI [26].…”

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

“…32,33 Typically, these ischemic infarcts occur between 10 and 72 hours after the injury. 7,34 Arterial transection can cause exsanguination and AVF. Patients with AVFs can have symptoms related to increased venous pressure or steal phenomenon.…”

Cervical Spine Decompression and Fusion Outcomes in Trauma Patients Actively Receiving Anticoagulation Treatment for Cerebrovascular Injury: A Retrospective Comparative Study

“…Controversy exists concerning the necessity of anticoagulation treatment following blunt traumatic vertebral artery injuries and their associated bleeding risks in those requiring spinal surgery. 8 Studies have shown better neurologic outcomes in patients who received anticoagulation treatment for cerebrovascular injury before symptoms arise. 1,8 Treating patients early with an anticoagulant has been shown to prevent progression to stroke or ischemia in patients with cerebrovascular (vertebral or carotid artery) injury.…”

“…2,6,7 Cerebrovascular injury can lead to neurovascular complications either from thrombus formation at the tear site or narrowing of the vessel. 8 Anticoagulation treatment begun in the early period (before the onset of stroke symptoms) has been shown to improve mortality and lower neurologic complications, but in patients having spinal surgery it carries the risk of epidural hematoma and major bleeding. [8][9][10][11] Although some studies provide recommendations as to when spine surgery patients should receive prophylaxis postoperatively to prevent deep vein thrombosis, 9,[12][13][14] few directly discuss the outcomes in patients who are actively receiving anticoagulation treat-ment.…”

“…8 Anticoagulation treatment begun in the early period (before the onset of stroke symptoms) has been shown to improve mortality and lower neurologic complications, but in patients having spinal surgery it carries the risk of epidural hematoma and major bleeding. [8][9][10][11] Although some studies provide recommendations as to when spine surgery patients should receive prophylaxis postoperatively to prevent deep vein thrombosis, 9,[12][13][14] few directly discuss the outcomes in patients who are actively receiving anticoagulation treat-ment. 15,16 Ideally anticoagulation treatment should be withheld until after spinal surgery has been completed, initiating treatment in the postoperative period.…”