Traumatic cerebrovascular injury: clinical characteristics and illustrative cases

Abstract

<jats:sec><jats:title>OBJECTIVE</jats:title><jats:p>Traumatic cerebrovascular injury (TCVI) is a rare and serious complication of traumatic brain injury (TBI). Various forms of TCVIs have been reported, including occlusions, arteriovenous fistulas, pseudoaneurysms, and transections. They can present at a variety of intervals after TBI and may manifest as sudden episodes, progressive symptoms, and even delayed fatal events. The purpose of this study was to analyze cases of TCVI identified at a single institution and further explore types and characteristics of these complications of TBI in order to improve recognition and treatment of these injuries.</jats:p></jats:sec><jats:sec><jats:title>METHODS</jats:title><jats:p>The authors performed a retrospective review of cases of TCVI identified at their institution between 2013 and 2016. A total of 5178 patients presented with TBI during this time period, and 42 of these patients qualified for a diagnosis of TCVI and had adequate medical and imaging records for analysis. Data from their cases were analyzed, and 3 illustrative cases are presented in detail.</jats:p></jats:sec><jats:sec><jats:title>RESULTS</jats:title><jats:p>The most common type of TCVI was arteriovenous fistula (86.4%), followed by pseudoaneurysm (11.9%), occlusion (2.4%), and transection (2.4%). The mortality rate of patients with TCVI was 7.1%.</jats:p></jats:sec><jats:sec><jats:title>CONCLUSIONS</jats:title><jats:p>The authors describe the clinical characteristics of patients with TCVI and provide data from a series of 42 cases. It is important to recognize TCVI in order to facilitate early diagnosis and treatment.</jats:p></jats:sec>

Case Report: Management of Traumatic Carotid-Cavernous Fistulas in the Acute Setting of Penetrating Brain Injury

“…As a matter of fact, the penetrating nature of gunshot wounds causing tCCF is, arguable, not unique. In the context of seemingly blunt trauma, basilar fractures may be associated with a penetrating mechanism causing vascular disruption (21). Gunshot wounds represent the end of a spectrum of injuries associated with tCCF (17).…”

Transorbital Intracranial Penetrating Injury from a Homemade Gun: A Case Report

“…4 8 9 Cerebral angiography should be concerned when a projectile or foreign body has entered the adjacent base of the skull, orbit, and facial bones. 5 8 9 Therefore, TOPI is a high risk to TCVI from the penetrating mechanism. Moreover, a foreign body is often positioned near intracranial vessels.…”

“…12 13 For long-term complications, postoperative cerebral angiogram or less-invasive vascular studies including MR angiography or CT angiography should be performed 1 to 3 months after the injury to evaluate delayed pseudoaneurysm. 9 10…”

Role of imaging in penetrating vascular injuries of the craniocervical region

“…[13] e sensitivity of CTA in detecting head-and-neck vascular injuries is 72.7% and 98-100%, respectively. [14] CTA guides clinicians in deciding the proper dissection management for good clinical outcomes. e variation in vessel caliber is the hallmark of vascular injury on imaging.…”

“…[ 19 ] The AVF (86%) is the most common imaging sign in PBI, followed by the pseudoaneurysm (12%), occlusion (2.4%), and transection (2.4%). [ 14 ] Risk factors of intracranial vascular injury include bi-hemispheric trajectory, entry wound located over the fronto-baso-parietal area, trajectory adjacent to the circle of Willis, and intraventricular hemorrhage (IVH) and IVH score, and subarachnoid hemorrhage (SAH) and SAH score. [ 20 ] The trajectory path in proximity to the circle of Willis (within 2 cm of the suprasellar cistern) comprises the most crucial risk factor for arterial injury.…”