Penetrating Vertebral Artery Injuries: A Literature Review and Proposed Treatment Algorithm

Piper, Keaton; Rabil, Maximilian J; Ciesla, David J.; Agazzi, Sivero; Ren, Zeguang; Mokin, Maxim; Guerrero, Waldo R

doi:10.1016/j.wneu.2021.01.021

Cited by 10 publications

(16 citation statements)

References 32 publications

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“…Fortunately, the paintbrush fragment did not damage vital structures such as arteries or nervous elements. For example, mortality rates following vertebral artery injuries range between 3 and 19%, including carotid artery injuries [ 10 ].…”

Section: Discussionmentioning

confidence: 99%

“…In the setting of head trauma and according to the PECARN and ACR recommendations, the boy was classified as very low risk for clinically important brain injury, which makes head CT scan evaluation not appropriate [ 9 , 10 ]. He was then discharged from the hospital with a pain management treatment consisting of paracetamol and ibuprofen.…”

Section: Case Presentationmentioning

confidence: 99%

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Nearly Missed Pharyngeal Foreign Body: A Three-Year-Old van Gogh

Haroun¹,

Simoni²,

Mansbach³

et al. 2022

Cureus

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Foreign body injuries in the head and neck region can be life-threatening. Managing pediatric patients in this context may be increasingly challenging due to several medical and legal reasons. In order to optimize the management of foreign body injuries and to guide treatment procedures, various imaging techniques, with specific assets and liabilities, must be employed. Nevertheless, the "As Low As Reasonably Achievable'' principle must be kept in mind when managing pediatric patients since children are more radiosensitive than adults. Guidelines for imaging pediatric head traumas are provided by the American College of Radiology (ACR), relying on the Pediatric Emergency Care Applied Research Network (PECARN) severity classification. We report the case of a three-year-old child in whom a considerable delay occurred in diagnosing a foreign body impaction, due to an occult clinical presentation. In this case study, we focus on outlining the importance of considering advanced imaging investigations for children in the wake of traumatic events.

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Section: Discussionmentioning

confidence: 99%

Section: Case Presentationmentioning

confidence: 99%

Nearly Missed Pharyngeal Foreign Body: A Three-Year-Old van Gogh

Haroun¹,

Simoni²,

Mansbach³

et al. 2022

Cureus

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“…However, a recent increase in incidence has been described, probably due to greater awareness and detection of this condition in high-risk patients [1,4,5]. Although the literature reports cases of traumatic injury to the vertebral artery by knives [5][6][7][8][9], there are few cases involving ischemic stroke secondary to a stab wound to the neck that affects the vertebral artery. Similar to the present case, Park et al described a case of cerebellar infarction produced by vertebral artery injury from a stab wound that separated the vessel between the transverse processes of C3 and C4 with a hypoplastic contralateral vertebral artery.…”

Section: Discussionmentioning

confidence: 99%

Ischemic Stroke Secondary to a Stab Wound to the Neck in a Young Adult

Zuluaga‐Gómez

Giraldo-Campillo

González‐Arroyave

et al. 2022

Case Reports in Medicine

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Vertebral artery dissection is a common cause of stroke in young adults without predisposing risk factors for cerebrovascular disease. We describe the case of a 28-year-old patient who presented with an ischemic stroke secondary to a stab wound to the neck that affected the vertebral artery. A physical examination revealed neurological deterioration (Glasgow 8/15), a sutured neck wound, no palpable hematoma, no thrills, and no active bleeding. A computed tomography angiography revealed a left vertebral artery arteriovenous fistula with a component of a pseudoaneurysm, for which a neurointerventional consultation was carried out. Due to neurological compromise, the airway was secured, and because the case involved a posterior fossa infarction with compression of the fourth ventricle and obstructive secondary hydrocephalus, an external ventricular shunt was inserted by neurosurgery. A fistula occlusion was performed with five Axium coils and a vial of Squid 12; the vertebral artery was catheterized, and a craniotomy was performed to manage hydrocephalus with a 12-mm H2O collecting system. The patient was discharged on the tenth day after admission with sequelae of left hemiparesis (predominantly brachial) and no other deficits. There was no hemorrhagic transformation on the control computed tomography scans and no further complications.

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“…Mortality rates associated with penetrating VA injury were documented to be 3–19%, but they may be underestimated for associated brainstem infarction that results in a rapid death before hospitalization. [ 11 ]…”

Section: Discussionmentioning

confidence: 99%

“…Alternative option is an open bypass surgery that may be beneficial for patients with an unstable VA injury and not amenable to endovascular treatment. [ 11 ]…”

Section: Discussionmentioning

confidence: 99%

Traumatic cervical vertebral artery aneurysm associated with suicidal stabs

Nonaka

Oishi

Tsutsumi

et al. 2021

Surgical Neurology International

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Background: Cervical vertebral artery (VA) aneurysm occasionally develops in association with penetrating injury. However, its treatment strategy is not yet determined. Case Description: A 50-year-old woman with bipolar disorder attempted suicide by stabbing herself in the lateral neck. At presentation, focal neurological deficits were not observed. Spinal computed tomography (CT) showed unclear delineation of the VA in the right C4/5 intervertebral foramen. CT performed 7 days later identified an aneurysm of the right VA at C4/5, with abnormal arteriovenous shunts between the aneurysm and paravertebral venous plexus. The patient underwent coil embolization of the VA segment involving the aneurysm on the same day that was complicated by cerebellar ataxia due to procedure-associated infarction. Conclusion: Traumatic VA aneurysms associated with penetrating injuries should be carefully managed with a detailed presurgical evaluation of the relevant cranial and spinal structures.

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Penetrating Vertebral Artery Injuries: A Literature Review and Proposed Treatment Algorithm

Cited by 10 publications

References 32 publications

Nearly Missed Pharyngeal Foreign Body: A Three-Year-Old van Gogh

Nearly Missed Pharyngeal Foreign Body: A Three-Year-Old van Gogh

Ischemic Stroke Secondary to a Stab Wound to the Neck in a Young Adult

Traumatic cervical vertebral artery aneurysm associated with suicidal stabs

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