Contributor: Aaron Lessen, MD
Educational Pearls:
Blunt cerebrovascular injury (BCVI)
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BCVI is a traumatic injury to the carotid or vertebral arteries
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Patients may initially have no neurologic symptoms
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In some cases, a thrombus can form at the site of the injury and later cause ischemic stroke, sometimes hours after the original trauma
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CT angiography (CTA) of the neck is a useful screening tool for BCVI
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HIstorically, CTA was reserved for patients with high-risk mechanisms or neurologic symptoms
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CTA screening has expanded as understanding of BCVIs and their prevention progresses
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The Denver criteria were developed to identify patients with increased risk for BCVI
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High-risk findings include cervical spine injuries and severe facial or skull-base fractures
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Screening practices still vary between trauma centers, though expansion of proactive CTA is an increasingly common practice
References
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Kim DY, 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.
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Biffl WL, et al. Screening for and treatment of blunt cerebrovascular injuries: Western Trauma Association critical decisions algorithm. J Trauma. 2009.
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Brommeland T, et al. Best practice guidelines for blunt cerebrovascular injury. Scand J Trauma Resusc Emerg Med. 2018.
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Harper PR, et al. Routine CTA screening identifies blunt cerebrovascular injuries missed by clinical risk factors. Trauma Surg Acute Care Open. 2022.
Summarized by Sam Pahl | Edited by Sam Pahl & Ahmed Abdel-Hafiz, NREMT-P
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