Ali Mansour1,2, Andrea Loggini3, Faten El Ammar3, Daniel Ginat4, Issam A Awad5, Christos Lazaridis3,5, Christopher Kramer3,5, Valentina Vasenina5, Sean P Polster5, Anna Huang6, Henry Olivera Perez6, Paramita Das5, Peleg M Horowitz5, Tanya Zakrison7, David Hampton7, Selwyn O Rogers7, Fernando D Goldenberg3,5. 1. Neurosciences Intensive Care Unit, Neurocritical Care, Department of Neurology, University of Chicago Medicine and Biological Sciences, 5841 S. Maryland Ave, MC 2030, Chicago, IL, 60637-1470, USA. ali.mansour@uchospitals.edu. 2. Section of Neurosurgery, Department of Surgery, University of Chicago Medicine and Biological Sciences, Chicago, IL, USA. ali.mansour@uchospitals.edu. 3. Neurosciences Intensive Care Unit, Neurocritical Care, Department of Neurology, University of Chicago Medicine and Biological Sciences, 5841 S. Maryland Ave, MC 2030, Chicago, IL, 60637-1470, USA. 4. Section of Neuroradiology, Department of Radiology, University of Chicago Medicine and Biological Sciences, Chicago, IL, USA. 5. Section of Neurosurgery, Department of Surgery, University of Chicago Medicine and Biological Sciences, Chicago, IL, USA. 6. Pritzker School of Medicine, University of Chicago Medicine and Biological Sciences, Chicago, IL, USA. 7. Section of Trauma and Acute Care Surgery, Department of Surgery, University of Chicago Medicine and Biological Sciences, Chicago, IL, USA.
Abstract
BACKGROUND: This study investigates the presence of cerebrovascular injuries in a large sample of civilian penetrating brain injury (PBI) patients, determining the prevalence, radiographic characteristics, and impact on short-term outcome. METHODS: We retrospectively reviewed patients with PBI admitted to our institution over a 2-year period. Computed tomography head scans, computer tomography angiograms and venograms of the intracranial vessels were evaluated to determine the wound trajectory, intracranial injury characteristics, and presence of arterial (AI) and venous sinus (VSI) injuries. Demographics, clinical presentation, and treatment were also reviewed. Discharge disposition was used as surrogate of short-term outcome. RESULTS: Seventy-two patients were included in the study. The mechanism of injury was gunshot wounds in 71 patients and stab wound in one. Forty-one of the 72 patients (60%) had at least one vascular injury. Twenty-six out of 72 patients suffered an AI (36%), mostly pseudoaneurysms and occlusions, involving the anterior and middle cerebral arteries. Of the 72 patients included, 45 had dedicated computed tomography venograms, and of those 22 had VSI (49%), mainly manifesting as superior sagittal sinus occlusion. In a multivariable regression model, intraventricular hemorrhage at presentation was associated with AI (OR 9.9, p = 0.004). The same was not true for VSI. CONCLUSION: Acute traumatic cerebrovascular injury is a prevalent complication in civilian PBI, frequently involving both the arterial and venous sinus systems. Although some radiographic features might be associated with presence of vascular injury, assessment of the intracranial vasculature in the acute phase of all PBI is essential for early diagnosis. Treatment of vascular injury remains variable depending on local practice.
BACKGROUND: This study investigates the presence of cerebrovascular injuries in a large sample of civilian penetrating brain injury (PBI) patients, determining the prevalence, radiographic characteristics, and impact on short-term outcome. METHODS: We retrospectively reviewed patients with PBI admitted to our institution over a 2-year period. Computed tomography head scans, computer tomography angiograms and venograms of the intracranial vessels were evaluated to determine the wound trajectory, intracranial injury characteristics, and presence of arterial (AI) and venous sinus (VSI) injuries. Demographics, clinical presentation, and treatment were also reviewed. Discharge disposition was used as surrogate of short-term outcome. RESULTS: Seventy-two patients were included in the study. The mechanism of injury was gunshot wounds in 71 patients and stab wound in one. Forty-one of the 72 patients (60%) had at least one vascular injury. Twenty-six out of 72 patients suffered an AI (36%), mostly pseudoaneurysms and occlusions, involving the anterior and middle cerebral arteries. Of the 72 patients included, 45 had dedicated computed tomography venograms, and of those 22 had VSI (49%), mainly manifesting as superior sagittal sinus occlusion. In a multivariable regression model, intraventricular hemorrhage at presentation was associated with AI (OR 9.9, p = 0.004). The same was not true for VSI. CONCLUSION: Acute traumatic cerebrovascular injury is a prevalent complication in civilian PBI, frequently involving both the arterial and venous sinus systems. Although some radiographic features might be associated with presence of vascular injury, assessment of the intracranial vasculature in the acute phase of all PBI is essential for early diagnosis. Treatment of vascular injury remains variable depending on local practice.
Authors: M Hachemi; C Jourdan; C Di Roio; F Turjman; A Ricci-Franchi; C Mottolese; F Artru Journal: Childs Nerv Syst Date: 2006-11-22 Impact factor: 1.475
Authors: Andrea Loggini; Valentina I Vasenina; Ali Mansour; Paramita Das; Peleg M Horowitz; Fernando D Goldenberg; Christopher Kramer; Christos Lazaridis Journal: J Crit Care Date: 2020-01-02 Impact factor: 3.425
Authors: Ruth Tangonan; Ronald Alvarado-Dyer; Andrea Loggini; Faten El Ammar; Ruchit Kumbhani; Christos Lazaridis; Christopher Kramer; Fernando D Goldenberg; Ali Mansour Journal: Neurocrit Care Date: 2022-01-24 Impact factor: 3.532
Authors: Andrea Loggini; Ali Mansour; Faten El Ammar; Christos Lazaridis; Christopher L Kramer; Zachary Bulwa; Faddi Saleh Velez; Cedric McCoy; Fernando D Goldenberg Journal: Neurocrit Care Date: 2021-04 Impact factor: 3.210
Authors: Andrea Loggini; Tareq Kass-Hout; Issam A Awad; Faten El Ammar; Christopher L Kramer; Fernando D Goldenberg; Christos Lazaridis; Ali Mansour Journal: Front Neurol Date: 2022-02-11 Impact factor: 4.003