“Practical approach to blunt cerebrovascular injury” From EM Quick Hits 11 With An Additional Resource From WikEM

Please see also Blunt neck trauma from WikEM, The Global Emergency Medicine Wiki.

In this post, I excerpt “Practical approach to blunt cerebrovascular injury” from EM Quick Hits 11 Blunt Cerebrovascular Injury, Physostigmine, TEE in Cardiac Arrest, Understanding Nystagmus, Subtle Inferior MI, Choicebo.

Andrew Petrosoniak on a practical approach to blunt cerebrovascular injury (29:43)

Practical approach to blunt cerebrovascular injury

  • Think about the possibility of blunt cerebrovascular injury in your head injured patients getting a CT head and/or neck, an often under-recognized phenomenon.
  • Non penetrating injury to the carotid or vertebral arteries in trauma can result in aneurysm, dissection (with subsequent ischemic stroke), and even transection.
  • The Denver Criteria have 97% sensitivity and 47% specificity for blunt cerebrovascular injury.
  • If positive by the Denver criteria, CTA of the head and neck is the imaging modality of choice in the ED.
  • Decision making in blunt cerebrovascular injury treatment involves weighing the risk of bleeding (in the trauma patient who may have other injuries) with anti-thrombotic medications, against the risk of stroke without these medications; consultation with neurosurgery/neurology is advised.

Denver screening criteria From WikEM

Denver screening criteria for blunt cerebrovascular injury

The Denver Screening Criteria are divided into risk factors and signs and symptoms

Signs and Symptoms

  • Arterial hemorrhage
  • Cervical bruit
  • Expanding neck hematoma
  • Focal neurologic deficit
  • Neuro exam inconsistent with head CT
  • Stroke on head CT

Risk Factors

  • Midface Fractures (Le Fort II or III)
  • Basilar Skull Fracture with carotid canal involvement
  • Diffuse axonal injury with GCS<6
  • Cervical spine fracture
  • Hanging with anoxic brain injury
  • Seat belt abrasion or other soft tissue injury of the anterior neck resulting in significant swelling or altered mental status
    • Isolated seatbelt sign without other neurologic symptoms has not been identified as a risk factor[5][6]

See Also

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