Predicting Arterial Injuries after Penetrating Brain Trauma Based on Scoring Signs from Emergency CT Studies

Bodanapally, Uttam K.; Krejza, Jarosław; Saksobhavivat, Nitima; Jaffray, Paul M.; Sliker, Clint W.; Miller, Lisa; Shanmuganathan, Kathirkamanathan; Dreizin, David

doi:10.15274/nrj-2014-10024

Cited by 12 publications

(7 citation statements)

References 14 publications

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“…7,8 Early detection and treatment of traumatic pseudoaneurysms would thus prevent secondary injury through haemorrhage. 9 A 12% incidence of traumatic pseudoaneurysms following stab head has previously been reported in our department. The same study also showed a mortality rate of 26% for patients who presented with the blade removed compared with 11% for those with the blade in place.…”

Section: Discussionmentioning

confidence: 73%

Comparing computed tomography (CT) angiography versus digital subtraction angiography for the screening of traumatic pseudoaneurysms in transcranial stab injuries

Karanja

Harrichandparsad

Royston³

et al. 2017

S. Afr. j. radiol.

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Introduction: Transcranial stab injuries among the civilian population in South Africa are more common than in the West. In a study conducted in Durban, South Africa, in 1992, transcranial stab injuries accounted for 6% of all head injuries admitted to the neurosurgical unit. Digital subtraction angiography (DSA) has been the gold standard for diagnosing traumatic pseudoaneurysms. Its use as a screening tool is, however, limited and carries risks of neurological deficits. We postulate that the newer generation computed tomography (CT) scanner would serve as a better screening tool for traumatic pseudoaneurysms following transcranial stab injuries with the blade removed, provided the image quality is good.Methods: All patients admitted with a stab to the head with total calvarial penetration from September 2014 to January 2016 were included in the study. Those with a retained metallic fragment, incomplete imaging protocols, no penetration of the blade into the brain parenchyma or other causes of penetrating head injury were not included in the study. A retrospective chart review was then done on a prospectively recruited patient cohort. All CT angiograms were performed using a dual source CT scanner.Results: A total of 26 patients met the inclusion criteria. There were seven vascular injuries identified on DSA: three traumatic pseudoaneurysms and four vessel cut-offs. One traumatic pseudoaneurysm was missed on computed tomography angiography (CTA) because of a poor quality scan. The average sensitivity and specificity of CTA compared with DSA was 67% and 95.5%, respectively. Negative predictive value for CTA was 99.5%.Conclusion: A good quality CTA carried out on the newer generation CT scanners allows for use of CTA as a screening tool for patients with a transcranial stab injury and no retained blade or metallic foreign bodies.

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Section: Discussionmentioning

confidence: 73%

Comparing computed tomography (CT) angiography versus digital subtraction angiography for the screening of traumatic pseudoaneurysms in transcranial stab injuries

Karanja

Harrichandparsad

Royston³

et al. 2017

S. Afr. j. radiol.

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“…Self-inflicted gunshot wounds are a rare event and a significant portion of these patients have their care terminated in the prehospital setting or in the trauma bay 24 . Thus the sample size is relatively small, which inherently limits any post hoc analysis of mortality/survival and other risk factors for vascular injury such as wound penetration near the Sylvian fissure and crossing of multiple dural compartments 3,25–27 . We are also not able to provide pertinent insight into subsequent management of CVIs largely due to the fact that conventional anticoagulation or antiplatelet treatment utilized in BCVIs would be acutely contra-indicated due to the risk of worsening intracerebral hemorrhage.…”

Section: Discussionmentioning

confidence: 98%

“…24 Thus the sample size is relatively small, which inherently limits any post hoc analysis of mortality/survival and other risk factors for vascular injury such as wound penetration near the Sylvian fissure and crossing of multiple dural compartments. 3,[25][26][27] We are also not able to provide pertinent insight into subsequent management of CVIs largely due to the fact that conventional anticoagulation or antiplatelet treatment utilized in BCVIs would be acutely contraindicated due to the risk of worsening intracerebral hemorrhage. Nonetheless, we have observed a strong association of not only CVIs, but distant CVIs within the SIGSW population and, therefore, we believe that these CVIs need to be screened for and found.…”

Section: Discussionmentioning

confidence: 99%

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

Yoon

Gebran²,

Elegbede

et al. 2021

Journal of Craniofacial Surgery

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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.

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“…The implication of all studies of GCS in deaths led Rish et al [16] as well as Levy et al [45] or Lieberman et al [46] to say that any patient admitted for PCCW with a GCS ≤ 5 had no reasonable chance of survival and should abstain from any surgical procedure. According to these three authors, including Bodanapally et al [15] the presence of SA hemorrhage was to be considered a significant factor associated with mortality. In addition to these clinical and therapeutic risk factors, which involved all causes of PCCW without distinction, there are also parameters that are sometimes specific to intracerebral gunshot PCCW.…”

Section: Discussionmentioning

confidence: 99%

Management and Prognostic Factors of Penetrating Craniocerebral Wounds at One Teaching Hospital in Benin

Fatigba¹,

Yarou²,

Quenum³

et al. 2021

OJMN

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Introduction. Penetrating craniocerebral wounds (PCCWs) are a particular lesion in the category of traumatic brain injury (TBI). The objective of this study was to describe the management of these lesions, and to identify signifiant risk factors associated with mortality in patients with a PCCW. Methods. It was a transversal, descriptive and analytical study performed in Departmental Teaching Hospital of Borgou and Alibori in Benin. From January 1, 2015 to June 30, 2020, patients with a PCCW were retained. Risk factors of mortality and morbidity associated to etiological, clinical and surgical parameters were assessed using the chi-square test. p value < 0.05 was considered to be statistically significant. Results. During the study period, 1267 cases of traumatic brain injuries (TBI) were admitted. Of these patients, 77 (6.1%) cases of PCCW were retained. These patients were divided into 66 (85.7%) male and 11 (14.3%) female. The mean age of the patients was 22.6 ± 14.8 years (range from 2 years to 70 years). The circumstances of occurrence were a traffic accident in 42 (54.5%) cases, an assault in 33 cases (42.9%) and a fall 2 (2.6%). The PCCW was unilateral in 71 cases (92.2%). A brain CT-scan was performed in 60 (77.9%) patients. Surgery was performed in 69 (89.6%) patients. Post-operative outcomes were simple in 59 (85.5%) cases. GCS, pupillary abnormalities, motor deficit were a statistically significant risk factor associated with death or sequels (p < 0.0001). Conclusion. The identification of risk factors of mortality or sequels is a major step for an efficient management of PCCWs and a reduction of morbidity and mortality. Whatever strategies are adopted, prevention must remain a priority.

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Predicting Arterial Injuries after Penetrating Brain Trauma Based on Scoring Signs from Emergency CT Studies

Abstract: SUMMARY -The objective of this study was to determine the accuracy of individual radiologists in detection of vascular injury in patients after penetrating brain injury (PBI) based on head CT

Cited by 12 publications

References 14 publications

Comparing computed tomography (CT) angiography versus digital subtraction angiography for the screening of traumatic pseudoaneurysms in transcranial stab injuries

Comparing computed tomography (CT) angiography versus digital subtraction angiography for the screening of traumatic pseudoaneurysms in transcranial stab injuries

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

Management and Prognostic Factors of Penetrating Craniocerebral Wounds at One Teaching Hospital in Benin

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