Nila H. Alsheik MD, Presenter: Nothing to Disclose

Lindell R. Gentry MD, Abstract Co-Author: Nothing to Disclose

The purpose of the study was to identify radiographic factors predictive of cerebrovascular injury (CVI) based on initial CT imaging of the head and cervical spine.

The diagnostic images and clinical records of 1975 consecutive patients presenting to a Level I Trauma Center with blunt craniocervical trauma were retrospectively reviewed in order to identify patients with CVI. Numerous radiographic factors were analyzed to identify patients that were at highest risk for traumatic CVI and deserving of vascular imaging workup. Factors analyzed included type and nature of skull, facial, spinal, and temporal bone fractures as well as the specific location and displacement of identified fractures.

CVI was classified according to location, vessel involved, and grade (1-5) of injury according to the Denver Grading Scale. Venous and arterial injuries were identified in 3% (n=59) and 1.7% (n=34) of the 1975 patients, respectively. Following radiographic analysis, 16% (n=328) of patients were considered to be in a group at highest risk for CVI. Of those patients in the highest risk group, 18% and 10% had injuries of the cerebral veins and arteries, respectively. 4.3% of the 93 patients with documented CVI had fatal injuries. 6.4% and 5.4% of CVI patients developed venous and arterial infarctions, respectively. We identified a significantly higher incidence of CVI associated with blunt craniocervical trauma than previously reported (0.05-1%) in the literature. Specific radiographic risk factors (e.g. carotid canal fracture) that are associated with CVI will be presented.

Patients with high-risk facial, skull base, and temporal bone fractures that propagate into the carotid canal, cervical spine fractures that involve the foramen transversarium, and fractures which cross major dural venous sinuses confer a significantly higher risk of CVI and should be routinely worked up with CTA or MRA. Patients with blunt craniocervical trauma without these high risk factors do not significantly benefit from routine vascular imaging.

An aggressive screening policy for CVI in patients with high-risk radiologic predictors of injury can result in more expedient diagnosis and treatment.

Alsheik, N, Gentry, L, Traumatic Cerebrovascular Injury Following Blunt Craniocervical Trauma.  Radiological Society of North America 2007 Scientific Assembly and Annual Meeting, November 25 - November 30, 2007 ,Chicago IL. http://archive.rsna.org/2007/5004384.html