Episode 923: Blunt Cerebrovascular Injury

Contributor: Travis Barlock MD

Educational Pearls:

• Assessment of head and neck vascular injury due to blunt trauma

• Symptomatic patients require screening head and neck CT angiography

• EAST guidelines include the following criteria for a screening CT angiography in blunt head trauma:

• Unexplained neurological deficits

• Arterial nosebleed

• GCS < 6

• Petrous bone fracture

• Cervical spine fracture

• Any size fracture through the transverse foramen

• LeFort fractures type II or type III

• EAST guidelines include a grading scale for vascular injury:

• Grade I: Luminal irregularity or dissection with <25% luminal narrowing

• Grade II: Dissection or intramural hematoma with >25% luminal narrowing, intraluminal thrombus, or raised intimal flap

• Grade III: Pseudoaneurysm

• Grade IV: Occlusion

• Grade V: Transection with free extravasation

References

1. Bensch FV, Varjonen EA, Pyhältö TT, Koskinen SK. Augmenting Denver criteria yields increased BCVI detection, with screening showing markedly increased risk for subsequent ischemic stroke. Emerg Radiol. 2019;26(4):365-372. doi:10.1007/s10140-019-01677-0

2. Biffl WL, Moore EE, Offner PJ, et al. Optimizing screening for blunt cerebrovascular injuries. Am J Surg. 1999;178(6):517-522. doi:10.1016/s0002-9610(99)00245-7

3. Kim DY, Biffl W, Bokhari F, et al. Evaluation and management of blunt cerebrovascular injury: A practice management guideline from the Eastern Association for the Surgery of Trauma. J Trauma Acute Care Surg. 2020;88(6):875-887. doi:10.1097/TA.0000000000002668

Summarized & Edited by Jorge Chalit, OMS3

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