Head and neck neurovascular trauma: Clinical and angiographic correlation

Abstract

<jats:p> A retrospective review of all angiograms done for craniocervical trauma, over an eight-year period at Groote Schuur Hospital identified 61 patients out of 823 angiographically studied who had extradural vascular injury and required endovascular treatment. Multiple lesions were identified in nine (14,8%) patients and associated injuries were found in 23 patients (37%). The mechanism of injury was blunt in nine (14.8%) patients and penetrating in 52 (85.2%). There was a statistically significant correlation between the presenting clinical feature and the underlying angiographic lesion. Patients with active bleeding were more likely to have a vessel laceration, an expanding hematoma was associated with false aneurysm and a pulsatile mass with arteriovenous fistula. Endovascular treatment with emphasis on vessel occlusion rather than preservation was successful in all cases except one which required surgical vessel ligation. </jats:p>

Simultaneous false aneurysm and arterio-venous fistula in the presence of a single wound

“…Blunt trauma is more rarely the cause and it is responsible for the remaining 10%. Gunshot wounds are the most frequent traumatic incidents, but stab wounds and iatrogenic lesions also account for traumatic AVF [ 1 , 2 , 4 , 5 , 7 , [11] , [12] , [13] , [14] , [15] ].…”

“…False aneurysms present as pulsatile, expansile swellings, and may be mistaken for abscesses particularly in view of their tendency to expand. Clinical examination of AVF shows a pathognomonic triad: palpable tumefaction, thrill above this change, and continuous systolic-diastolic murmur on auscultation [ 1 , 2 , 5 , 12 , 14 , 16 ]. In the current case the expansile, pulsatile mass indicated a false aneurysm; the machinery-like murmur alerted us to the possibility of a concurrent AV fistula.…”

Internal Carotid Artery Dissection in Brazilian Jiu-Jitsu

“… 8) On the other hand, this particular dissection involved the origin of internal carotid artery, suggesting the following biomechanical sequence: 1) carotid artery compression, creating a point of fixation and 2) subsequent hyperextension of the neck, with contralateral head rotation. 22) The resultant traction would suffice to stretch and rupture the intimal layer of carotid artery distal to its point of fixation ( Fig. 3 ).…”

“…Emergency stenting also serves to stabilize the intimal flap and deter potential deterioration precipitated by emboli. 22) Thrombolysis of intracerebral occlusions in an acute phase is also a safe and effective option, even following extracranial carotid artery stenting. 15) It was contraindicated in this patient since he was beyond the 6-hour time window and had major involvement (over one-third) of the territory supplied by middle cerebral artery, heightening the risk of intracerebral hemorrhage.…”

Vascular Trauma in the Head and Neck and Endovascular Neurointerventional Management

“…Vascular injury may be present in up to 3%–20% of cases of blunt and penetrating craniocervical injury. [ 1 ] It is imperative to detect vascular injuries to prevent or mitigate the risk of complications such as hemorrhage, vessel occlusion, and thromboembolic stroke. Although conventional angiography is considered the gold standard for detection and characterization of these injuries, computed tomographic angiography (CTA) is more readily available and also a highly sensitive modality to screen for such vascular injuries.…”