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Emerg Radiol. 2019 Feb;26(1):75-85. doi: 10.1007/s10140-018-1630-y. Epub 2018 Aug 10.

Blunt traumatic vascular injuries of the head and neck in the ED.

Author information

1
Department of Radiology, Brigham and Women's Hospital and Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA. egeorge6@partners.org.
2
Department of Radiology, Mayo Clinic, Rochester, MN, USA.
3
Department of Radiology, Brigham and Women's Hospital and Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA.

Abstract

Cerebrovascular injury is increasingly identified in patients presenting after blunt trauma due to the implementation of screening criteria and advances in noninvasive angiographic imaging by CT. The variable latent time before onset of secondary stroke presents a window of opportunity for prevention, reinforcing the importance of detection of asymptomatic patients via screening. Furthermore, the high morbidity and mortality associated with secondary stroke makes it imperative that radiologists recognize these challenging injuries. This article reviews the epidemiology of and the various proposed screening criteria for blunt cerebrovascular injury. The imaging findings of extra- and intracranial vascular injuries, including arterial and venous trauma, are reviewed along with the grading system. Conservative management with anticoagulation has gained favor over the years with intervention restricted to high-grade injuries such as transection and hemodynamically significant arteriovenous fistula. Many of these injuries also evolve over time, with or without anticoagulation, necessitating imaging follow-up.

KEYWORDS:

Blunt cerebrovascular injury; CT angiography; Head and neck; Trauma

PMID:
30097750
DOI:
10.1007/s10140-018-1630-y
[Indexed for MEDLINE]

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