Treatment strategies for patients with concurrent blunt cerebrovascular and traumatic brain injury

Neurointerventional management of cerebrovascular trauma

“…Оскільки тупа травма може поширюватися на великі ділянки тіла, під час тупого цереброваскулярного ушкодження (ТЦВУ) часто відбувається травмування декількох судин. Як при ТЦВУ, так і при проникаючому цереброваскулярному ушкодженні (ПЦВУ) з ураженням судин, найчастіше ушкоджуються екстракраніальні відділи сонних артерій [11][12][13], що свідчить про захист хребтових і внутрішньочерепних артерій шийним відділом хребта та черепом [14]. У разі ПЦВУ також часто спостерігають ушкодження внутрішніх яремних вен та інших магістральних вен шиї.…”

Neurointerventional management of cerebrovascular trauma

“…Since blunt trauma can affect large body regions, blunt cerebrovascular injury (BCVI) often involves multiple vessels. In both BCVI and penetrating cerebrovascular injuries (PCVI), the extracranial carotid arteries are most vulnerable,11–13 ostensibly reflecting the protection of the vertebral arteries and intracranial arteries conferred by the cervical spine and skull 14. PCVI also frequently involves the internal jugular veins or other major veins in the neck.…”

“…For instance, up to 9.2% of patients with severe traumatic brain injury have accompanying BCVI 59. In such cases, mitigation of secondary ischemic risk of BCVI may incur an elevated risk of intracranial hemorrhage or expansion of hemorrhagic contusions 14…”

Incidence of Blunt Brain and Neck Injury by Blast in Colombian Military Personnel: A Cases Review

“…Patients with some type of management where we see that: in patients without treatment, there is a 25% probability of stroke vs management those who have received at least one treatment option, either antiplatelet 8%, anticoagulant 7%, endovascular 5% or with any treatment (3%) [3]. This pathology is frequently described in traffic accidents or falls of heights of more than two or three floors [7] where the mechanism of injury can be found as a direct head trauma of high energy or cervical trauma of hyperflexion, hyperextension and/or rotational; cervical vascular lesions associated with the exercise of chiropractic have also been found [8]; There are the Denver criteria that were extended in 2011 in order to identify the clinical and risk factors associated with blunt injury, this modification managed to increase sensitivity and specificity (97%) and (42%) respectively in the diagnosis [8] these criteria along with those of Memphis can also be used to indicate a radiological screening. [4] it is important to note that the incidence of Blunt Injury increases, if associated injuries occur for example, there is an increase of this to 3-5% if there are skull base fractures, Intraparenchymal hemorrhages and when there are complex cervical lesions its incidence increases from 25%-30%; the most frequent sequelae is stroke that appear in 41% when there are lesions of the internal carotid artery [9] and 25% when there are lesions of the vertebral arteries [7,10,11] Stroke occurs in the first 3 days by 60% by 85% in the first 7 days of the traumatic event [2,8].…”

“…This pathology is frequently described in traffic accidents or falls of heights of more than two or three floors [7] where the mechanism of injury can be found as a direct head trauma of high energy or cervical trauma of hyperflexion, hyperextension and/or rotational; cervical vascular lesions associated with the exercise of chiropractic have also been found [8]; There are the Denver criteria that were extended in 2011 in order to identify the clinical and risk factors associated with blunt injury, this modification managed to increase sensitivity and specificity (97%) and (42%) respectively in the diagnosis [8] these criteria along with those of Memphis can also be used to indicate a radiological screening. [4] it is important to note that the incidence of Blunt Injury increases, if associated injuries occur for example, there is an increase of this to 3-5% if there are skull base fractures, Intraparenchymal hemorrhages and when there are complex cervical lesions its incidence increases from 25%-30%; the most frequent sequelae is stroke that appear in 41% when there are lesions of the internal carotid artery [9] and 25% when there are lesions of the vertebral arteries [7,10,11] Stroke occurs in the first 3 days by 60% by 85% in the first 7 days of the traumatic event [2,8]. The before mentioned denotes the relevance and importance of being able to make an adequate and timely diagnosis of this pathology, not only because of the impact it can have on mortality, but also the high morbidity that it generates, not being able to make an adequate diagnosis and management; taking this into account, in addition to the trauma mechanisms that can generate this pathology, a retrospective review of cases in military personnel who presented high-energy traumas and the incidence of Blunt Injury in these patients is made.…”