Blunt Cerebrovascular Injury-Like Injury Observed in Patients With Craniofacial Self-Inflicted Gunshot Wounds

Abstract

Background: Although blunt cerebrovascular injury (BCVI) is recognized as a risk factor for trauma morbidity and mortality, little is described regarding similar cerebrovascular injury (CVI) in patients with penetrating wounds. The authors aim to characterize these injuries in the craniofacial self-inflicted gunshot wound (SIGSW) population. Methods: An institutional review board (IRB)-approved retrospective nstudy was conducted on patients presenting to the R Adams Cowley Shock Trauma Center with SIGSWs between 2007 and 2016. All CVIs were categorized by location, type, and associated neurologic deficits. Demographic data, patient characteristics, additional studies, and long-term outcomes were collected. A multivariate analysis determining independent predictors of CVI in the SIGSW population was performed. Results: Of the 73 patients with SIGSWs, 5 (6.8%) had CVIs separate from the bullet/cavitation tract (distant CVIs) and 9 had CVIs along the bullet/cavitation tract (in-tract CVIs). A total of 55.6% of in-tract and 40% of distant injuries were missed on initial radiology read. One distant CVI patient suffered a stroke during admission. The anterior to posterior gunshot wound trajectory was positively associated with distant CVIs when compared with no CVIs (P ¼ 0.01). Vessel dissection was more prevalent in patients with distant CVIs, when compared against patients with in-tract CVIs (P ¼ 0.02).Conclusions: Nearly 20% of craniofacial SIGSW patients have CVIs and 6.8% have BCVI-like injuries, which is 2-to-6-fold times higher than traditional BCVIs. Craniofacial SIGSWs serve as an independent screening criterion with comparable screening yields; the authors recommend radiographic screening for these patients with particular scrutiny for CVIs as they are frequently missed on initial radiographic interpretations.

Blunt Cerebrovascular Injury in the Elderly With Traumatic Cervical Spine Injuries: Results of a Retrospective Multi-Center Study of 1512 Cases in Japan

“… 8–15 The injury characteristics, cause of trauma, complications following injury, symptom progress, neurological recovery, outcome, treatment approach, and BCVI-related data in elderly patients are different from those of younger and middle-age patients. 6 , 7 , 8–13 , 15 Despite a consistent trend toward older age when CSI occurs, only a few articles have reported on the most severe complication caused by CSI in elderly patients, that of BCVI. 6 , 7 , 15 When the doctors miss several important diagnostic clues, brain dysfunction or fatal complications will be led by medical misdiagnosis.…”

“… 6 , 7 , 8–13 , 15 Despite a consistent trend toward older age when CSI occurs, only a few articles have reported on the most severe complication caused by CSI in elderly patients, that of BCVI. 6 , 7 , 15 When the doctors miss several important diagnostic clues, brain dysfunction or fatal complications will be led by medical misdiagnosis. Therefore, diagnosis of BCVI at the first emergency unit is quite important.…”

“… 15–21 Even though only a small number of patients present with neurologic deficits following acute traumatic VAI, consequences can be severe if an ischemic or embolic phenomenon occurs after delayed presentation due to a missed diagnosis. 6 , 7 It is thus critical to recognize BCVI early in this vulnerable population. Screening guidelines are available to identify patients at high risk for BCVI following CSI to determine those who should undergo cervical computed tomography angiography (CTA).…”

“…Screening guidelines are available to identify patients at high risk for BCVI following CSI to determine those who should undergo cervical computed tomography angiography (CTA). 6 , 7 Still, patients presenting with atypical radiographic or injury findings may be missed, and contrast media injected during CTA may harm kidney function, especially in elderly patients. Therefore, characteristics of the risk factors for BCVI in the elderly should be revealed, and a routine screening system for elderly patients with CSI is needed to prevent severe complications following BCVI.…”

“…Therefore, characteristics of the risk factors for BCVI in the elderly should be revealed, and a routine screening system for elderly patients with CSI is needed to prevent severe complications following BCVI. 6 , 7 , 15 …”