Blunt Traumatic Extracranial Cerebrovascular Injury and Ischemic Stroke

Abstract

Background: Ischemic stroke occurs in a significant subset of patients with blunt traumatic cerebrovascular injury (TCVI). The patients are victims of motor vehicle crashes, assaults or other high-energy collisions, and suffer ischemic stroke due to injury to the extracranial carotid or vertebral arteries. Summary: An increasing number of patients with TCVI are being identified, largely because of the expanding use of computed tomography angiography for screening patients with blunt trauma. Patients with TCVI are particularly challenging to manage because they often suffer polytrauma, that is, numerous additional injuries including orthopedic, chest, abdominal, and head injuries. Presently, there is no consensus about optimal management. Key Messages: Most literature about TCVI and stroke has been published in trauma, general surgery, and neurosurgery journals; because of this, and because these patients are managed primarily by trauma surgeons, patients with stroke due to TCVI have been essentially hidden from view of neurologists. This review is intended to bring this clinical entity to the attention of clinicians and investigators with specific expertise in neurology and stroke.

Stroke Secondary to Traumatic Carotid Artery Injury – A Case Report

“…Often, patients that require screening for BCVI also need a CT scan of other regions of the body, such as the spinal cord, chest and abdomen. (5,13) CT devices with 16 or more slices have a high sensitivity and specificity for this type of injury. DSA is necessary when the results of other imaging methods are equivocal.…”

“…Ischemic stroke appears in 10 to -20% of patients with BCVI. (5) If unrecognised and untreated, the reported incidence increases to near 60 %. (6) This case report aims to highlight the characteristics of a classic case of stroke secondary to TCAI and to discuss the literature data regarding the epidemiology, clinical presentation, diagnostic workup and treatment.…”

Critical Care Management of Acute Spinal Cord Injury—Part II: Intensive Care to Rehabilitation

“…Intimal defects provide a pathway for blood to enter the layers of the artery wall, which may cascade into one or more mechanisms of injury. 55 Simple exposure of subendothelial collagen initiates platelet aggregation and thrombus formation, which may lead to stenosis, occlusion, or embolization. Less commonly, a subintimal dissection may occur and advance cranially, with further risk of luminal narrowing or vessel occlusion.…”

Untitled

“…About 15% of IS s occur due to extracurricular carotid artery stenosis. [9] The cause of artery stenosis in most cases has been reported as atherosclerosis, endothelial damage, fat accumulation, inflammation, plaque formation, fibrin, platelet, and thrombin. [10] Angiography is a gold standard diagnostic tool for carotid stenosis, but it is an expensive and invasive method with potentially serious side effects.…”