Carotid and Vertebral Artery Occlusion after Blunt Cervical Injury

Bok, Arnold; Peter, Jonathan C.

doi:10.1097/00005373-199606000-00017

Cited by 110 publications

(45 citation statements)

References 28 publications

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“…1 However, IA-DSA is resource intensive, not necessarily completely sensitive, and carries a small yet significant risk for neurologic morbidity. More recently, various improved noninvasive imaging techniques such as MR angiography, 27 duplex sonography (DUS), and CTA 28 have been studied for their potential role in the diagnosis of BCVI. MR imaging is at a disadvantage because of its limited availability in the acute trauma setting.…”

Section: Discussionmentioning

confidence: 99%

Whole-Body CT Trauma Imaging with Adapted and Optimized CT Angiography of the Craniocervical Vessels: Do We Need an Extra Screening Examination?

Langner¹,

Fleck²,

Kirsch³

et al. 2008

AJNR Am J Neuroradiol

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Section: Discussionmentioning

confidence: 99%

Whole-Body CT Trauma Imaging with Adapted and Optimized CT Angiography of the Craniocervical Vessels: Do We Need an Extra Screening Examination?

Langner¹,

Fleck²,

Kirsch³

et al. 2008

AJNR Am J Neuroradiol

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“…A risk of 7.9% for a potentially lethal injury is still significant, and if there is strong clinical suspicion of BCVI despite a low prediction score, delayed MR angiography may be considered as an alternative screening modality that avoids radiation in lower-risk patients. 5,28 Risk modeling in large adult populations is commonly used to guide BCVI screening in practice (with the Denver criteria); 4 patients with no risk factors for blunt ICA injury and for whom screening is not recommended have a 20% risk for BCVI. By comparison, we have defined a pediatric population at much lower risk.…”

Section: Limitationsmentioning

confidence: 99%

Risk factors for traumatic blunt cerebrovascular injury diagnosed by computed tomography angiography in the pediatric population: a retrospective cohort study

Ravindra

Riva-Cambrin

Sivakumar

et al. 2015

PED

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OBJECT Computed tomography angiography (CTA) is frequently used to examine patients for blunt cerebrovascular injury (BCVI) after cranial trauma, but the pediatric population at risk for BCVI is poorly defined. Although CTA is effective for BCVI screening in adults, the increased lifetime risk for malignant tumors associated with this screening modality warrants efforts to reduce its use in children. The authors' objective was to evaluate the incidence of BCVI diagnosed by CTA in a pediatric patient cohort and to create a prediction model to identify children at high risk for BCVI. METHODS Demographic, clinical, and radiographic data were collected retrospectively for pediatric patients who underwent CTA during examination for traumatic cranial injury from 2003 through 2013. The primary outcome was injury to the carotid or vertebral artery diagnosed by CTA. RESULTS The authors identified 234 patients (mean age 8.3 years, range 0.04–17 years, 150 [64%] boys) who underwent CTA screening for BCVI. Of these, 24 (10.3%) had a focal neurological deficit, and 153 (65.4%) had intracranial hemorrhage on a head CTA. Thirty-seven BCVIs were observed in 36 patients (15.4%), and 16 patients (6.8%) died. Multivariate regression analysis identified fracture through the carotid canal, petrous temporal bone fracture, Glasgow Coma Scale (GCS) score of < 8, focal neurological deficit, and stroke on initial CT scan as independent risk factors for BCVI. A prediction model for identifying children at high risk for BCVI was created. A score of ≤ 2 yielded a 7.9% probability of BCVI and a score of ≥ 3 a risk of 39.3% for BCVI. CONCLUSIONS For cranial trauma in children, fracture of the petrous temporal bone or through the carotid canal, focal neurological deficit, stroke, and a GCS score of < 8 are independent risk factors for BCVI.

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“…14,15 A high clinical index of suspicion remains the most important factor in making the diagnosis. 16 Clinicians should consider the dangers of VA injury in all patients who have sustained any type of cervical spine injury. Once a patient is found to be at risk of VA injury, imaging studies should be taken to rule out VA injury and avoid neurological deterioration, even if there are no symptoms of vertebrobasilar insufficiency such as altered consciousness, dysarthria, blurred vision, nystagmus, ataxia, or dysphagia.…”

Section: Discussionmentioning

confidence: 99%

Distal Embolic Brain Infarction Due to Recanalization of Asymptomatic Vertebral Artery Occlusion Resulting From Cervical Spine Injury: A Case Report

Nakao

Terai

2014

Journal of Chiropractic Medicine

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Objective: The purpose of this case report is to describe a patient with brain infarction due to recanalization of an occluded vertebral artery (VA) following closed reduction and open fixation of cervical spinal dislocation and to discuss the management of asymptomatic VA injuries associated with spine trauma. Clinical Features: A 41-year-old Asian man experienced a C4-5 distractive-flexion injury manifesting with quadriplegia and anesthesia below the C3 cord level (including phrenic nerve paralysis), and bowel and bladder dysfunction. Magnetic resonance angiography and computed tomography angiography showed left extracranial VA (V2) occlusion and a patent contralateral VA. Intervention and Outcome: The patient was observed without antiplatelet and/or anticoagulation therapy and underwent open reduction and internal fusion of C4/5 and tracheostomy 8 hours after the injury. After surgery, supraspinal symptoms such as left horizontal nystagmus and left homonymous hemianopsia led to cranial computed tomography and magnetic resonance imaging, which showed left-side cerebellar infarction in the posterior inferior cerebellar artery territory and right-side posterior cerebral artery infarction. Magnetic resonance angiography and computed tomography angiography demonstrated patent bilateral VA (but hypoplastic right VA) and occluded right posterior cerebral artery. The injured VA was treated conservatively, and there were no other ischemic complications. Conclusion: The management of asymptomatic VA injury is controversial, with several treatment options available, including observation alone, antiplatelet therapy, anticoagulation therapy, or invasive intervention. Although there are some reports described where management with observation alone seems safe, serious attention should be given to the VA injury caused by cervical spine trauma.

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Carotid and Vertebral Artery Occlusion after Blunt Cervical Injury

Cited by 110 publications

References 28 publications

Whole-Body CT Trauma Imaging with Adapted and Optimized CT Angiography of the Craniocervical Vessels: Do We Need an Extra Screening Examination?

Whole-Body CT Trauma Imaging with Adapted and Optimized CT Angiography of the Craniocervical Vessels: Do We Need an Extra Screening Examination?

Risk factors for traumatic blunt cerebrovascular injury diagnosed by computed tomography angiography in the pediatric population: a retrospective cohort study

Distal Embolic Brain Infarction Due to Recanalization of Asymptomatic Vertebral Artery Occlusion Resulting From Cervical Spine Injury: A Case Report

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