In this post I link to and excerpt from the portion of EM Quick Hits 11 [Link is to the podcast and show notes] that discusses “Blunt Cerebrovascular Injury” [from 29:43 to 38:45] , December, 2019 by Emergency Medicine Cases.
After the show notes to Blunt Cerebrovascular Injury, I’ve included links to vertebral and carotid artery dissection and the Denver Screening Criteria Both of these resources are from WikiEM. And both are quick but important reviews on the subject.
Here are the show notes from Blunt Cerebral Injury:
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.