BACKGROUND: The recognition that early diagnosis and intervention, prior to ischemic neurologic injury, has the potential to improve outcome following blunt cerebrovascular injuries (BCVI), led to a policy of aggressive screening for these injuries. The resultant epidemic of BCVI has created a dilemma, as widespread screening is impractical. We sought to identify independent predictors of BCVI, to focus resources. METHODS: Cerebral arteriography was performed based on signs or symptoms of BCVI, or in asymptomatic patients with high-risk mechanisms (hyperextension, hyperflexion, direct blow) or injury patterns. Logistic regression analysis identified independent predictors. RESULTS: A total of 249 patients underwent arteriography; 85 (34%) had injuries. Independent predictors of carotid arterial injury were Glasgow coma score < or =6, petrous bone fracture, diffuse axonal brain injury, and LeFort II or III fracture. Having one of these factors in the setting of a high-risk mechanism was associated with 41% risk of injury. Of patients with cervical spine fracture, 39% had vertebral arterial injury. CONCLUSIONS: Patients sustaining high-risk injury mechanisms or patterns should be screened for BCVI. In the face of limited resources, screening efforts should be focused on those with high-risk predictors.
BACKGROUND: The recognition that early diagnosis and intervention, prior to ischemic neurologic injury, has the potential to improve outcome following blunt cerebrovascular injuries (BCVI), led to a policy of aggressive screening for these injuries. The resultant epidemic of BCVI has created a dilemma, as widespread screening is impractical. We sought to identify independent predictors of BCVI, to focus resources. METHODS: Cerebral arteriography was performed based on signs or symptoms of BCVI, or in asymptomatic patients with high-risk mechanisms (hyperextension, hyperflexion, direct blow) or injury patterns. Logistic regression analysis identified independent predictors. RESULTS: A total of 249 patients underwent arteriography; 85 (34%) had injuries. Independent predictors of carotid arterial injury were Glasgow coma score < or =6, petrous bone fracture, diffuse axonal brain injury, and LeFort II or III fracture. Having one of these factors in the setting of a high-risk mechanism was associated with 41% risk of injury. Of patients with cervical spine fracture, 39% had vertebral arterial injury. CONCLUSIONS:Patients sustaining high-risk injury mechanisms or patterns should be screened for BCVI. In the face of limited resources, screening efforts should be focused on those with high-risk predictors.
Authors: Christian D Weber; Rolf Lefering; Philipp Kobbe; Klemens Horst; Miguel Pishnamaz; Richard M Sellei; Frank Hildebrand; Hans-Christoph Pape Journal: World J Surg Date: 2018-07 Impact factor: 3.352
Authors: Megan M Lockwood; Gabriel A Smith; Joseph Tanenbaum; Daniel Lubelski; Andreea Seicean; Jonathan Pace; Edward C Benzel; Thomas E Mroz; Michael P Steinmetz Journal: J Neurosurg Spine Date: 2015-11-27
Authors: J M Romero; H R Kelly; J E Delgado Almandoz; J Hernandez-Siman; J C Passanese; M H Lev; R G González Journal: AJNR Am J Neuroradiol Date: 2013-02-28 Impact factor: 3.825
Authors: Nancy K Hills; S Claiborne Johnston; Stephen Sidney; Brandon A Zielinski; Heather J Fullerton Journal: Ann Neurol Date: 2012-12 Impact factor: 10.422