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Cerebrovascular Dissections: A Review. Part II: Blunt Cerebrovascular Injury

Fusco, Matthew R MD; Harrigan, Mark R MD

Neurosurgery:
doi: 10.1227/NEU.0b013e3181fe2fda
Review
Abstract

Traumatic cerebrovascular injury (TCVI) is present in approximately 1% of all blunt force trauma patients and is associated with injuries such as head and cervical spine injuries and thoracic trauma. Increased recognition of patients with TCVI in the past quarter century has been because of aggressive screening protocols and noninvasive imaging with computed tomography angiography. Extracranial carotid and vertebral artery injuries demonstrate a spectrum of severity, from intimal disruption to traumatic aneurysm formation or vessel occlusion. The most common intracranial arterial injuries are carotid-cavernous fistulae and traumatic aneurysms. Data on the long-term natural history of TCVI are limited, and management of patients with TCVI is controversial. Although antithrombotic medical therapy is associated with improved neurological outcomes, the optimal medication regimen is not yet established. Endovascular techniques have become more popular than surgery for the treatment of TCVI; endovascular options include stenting of dissections, intra-arterial thrombolysis for acute ischemic stroke caused by trauma, and embolization of traumatic aneurysms.

Author Information

Department of Surgery, Division of Neurosurgery, University of Alabama at Birmingham, Birmingham, Alabama

Received, December 15, 2009.

Accepted, June 4, 2010.

Correspondence: Mark R. Harrigan, MD, Faculty Office Tower 1005, 510 20th Street South, Birmingham, AL 35294. E-mail: mharrigan@uabmc.edu

Copyright © by the Congress of Neurological Surgeons