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Blunt injury on cerebrovascular

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https://www.readbyqxmd.com/read/27781188/blunt-cerebrovascular-injury-in-cervical-spine-fractures-are-more-liberal-screening-criteria-warranted
#1
Gregory Grabowski, Ryan N Robertson, Blair M Barton, Mark A Cairns, Sharon W Webb
Study Design Retrospective comparative study. Objective To compare strict Biffl criteria to more-liberal criteria for computed tomography angiography (CTA) when screening for blunt cerebrovascular injury (BCVI). Methods All CTAs performed for blunt injury between 2009 and 2011 at our institution were reviewed. All patients with cervical spine fractures who were evaluated with CTA were included; patients with penetrating trauma and atraumatic reasons for imaging were excluded. We then categorized the patients' fractures based on the indications for CTA as either within or outside Biffl criteria...
November 2016: Global Spine Journal
https://www.readbyqxmd.com/read/27767400/reliability-assessment-of-the-biffl-scale-for-blunt-traumatic-cerebrovascular-injury-as-detected-on-computer-tomography-angiography
#2
Paul M Foreman, Christoph J Griessenauer, Kimberly P Kicielinski, Philip G R Schmalz, Brandon G Rocque, Matthew R Fusco, Joseph C Sullivan, John P Deveikis, Mark R Harrigan
OBJECTIVE Blunt traumatic cerebrovascular injury (TCVI) represents structural injury to a vessel due to high-energy trauma. The Biffl Scale is a widely accepted grading scheme for these injuries that was developed using digital subtraction angiography. In recent years, screening CT angiography (CTA) has been used to identify patients with TCVI. The reliability of this scale, with injuries assessed using CTA, has not yet been determined. METHODS Seven independent raters, including 2 neurosurgeons, 2 neuroradiologists, 2 neurosurgical residents, and 1 neurosurgical vascular fellow, independently reviewed each presenting CTA of the neck performed in 40 patients with confirmed TCVI and assigned a Biffl grade...
October 21, 2016: Journal of Neurosurgery
https://www.readbyqxmd.com/read/27751528/expanded-screening-criteria-for-blunt-cerebrovascular-injury-a-bigger-impact-than-anticipated
#3
Andrea E Geddes, Clay Cothren Burlew, Amy E Wagenaar, Walter L Biffl, Jeffrey L Johnson, Fredric M Pieracci, Eric M Campion, Ernest E Moore
BACKGROUND: We implemented expanded screening criteria for blunt cerebrovascular injuries (BCVIs) in an attempt to capture the remaining 20% of patients not historically identified with earlier protocols. We hypothesized that these expanded criteria would capture the additional 20% of BCVI patients not previously identified. METHODS: Screening criteria for BCVI were expanded in 2011 after identifying new injury patterns. The study population included 4 years prior (2007 to 2010; classic) and following (2011 to 2014; expanded) implementation of expanded criteria...
September 29, 2016: American Journal of Surgery
https://www.readbyqxmd.com/read/27537517/long-term-follow-up-of-blunt-cerebrovascular-injuries-does-time-heal-all-wounds
#4
Adriana Laser, Brandon R Bruns, Joseph Kufera, Andrew Kim, Timothy Feeney, Ronald B Tesoriero, Margaret H Lauerman, Clint W Sliker, Thomas M Scalea, Deborah M Stein
BACKGROUND: The short-term natural history of blunt cerebrovascular injuries (BCVI) has been previously described in the literature, but the purpose of this study is to analyze long-term serial follow-up and lesion progression of BCVI. METHODS: This is a single institution's retrospective review of a prospectively collected database over four years (2009-2013). All patients diagnosed with BCVI by CT scan were identified and injuries graded based on modified Denver scale...
August 18, 2016: Journal of Trauma and Acute Care Surgery
https://www.readbyqxmd.com/read/27533909/unfractionated-heparin-after-tbi-reduces-in-vivo-cerebrovascular-inflammation-brain-edema-and-accelerates-cognitive-recovery
#5
Katsuhiro Nagata, Kenichiro Kumasaka, Kevin D Browne, Shengjie Li, Jesse St-Pierre, John Cognetti, Joshua Marks, Victoria E Johnson, Douglas H Smith, Jose L Pascual
BACKGROUND: Severe traumatic brain injury (TBI) may increase the risk of venous thromboembolic complications; however, early prevention with heparinoids is often withheld for its anticoagulant effect. New evidence suggests low molecular weight heparin reduces cerebral edema and improves neurological recovery after stroke and TBI, through blunting of cerebral leukocyte (LEU) recruitment. It remains unknown if unfractionated heparin (UFH) similarly affects brain inflammation and neurological recovery post-TBI...
December 2016: Journal of Trauma and Acute Care Surgery
https://www.readbyqxmd.com/read/27297774/predicting-blunt-cerebrovascular-injury-in-pediatric-trauma-validation-of-the-utah-score
#6
Vijay M Ravindra, Robert Bollo, Walavan Sivakumar, Hassan Akbari, Robert P Naftel, David D Limbrick, Andrew Jea, Stephen R Gannon, Chevis Shannon, Yekaterina Birkas, George L Yang, Colin T Prather, John Kestle, Jay Riva-Cambrin
Risk factors for blunt cerebrovascular injury (BCVI) may differ between children and adults, suggesting that children at low risk for BCVI after trauma receive unnecessary computed tomography angiography (CTA) and high-dose radiation. We previously developed a score for predicting pediatric BCVI based on retrospective cohort analysis. Our objective is to externally validate this prediction score with a retrospective multi-institutional cohort. We included patients who underwent CTA for traumatic cranial injury at four pediatric level-one trauma centers...
June 13, 2016: Journal of Neurotrauma
https://www.readbyqxmd.com/read/27104846/clinical-utility-of-a-screening-protocol-for-blunt-cerebrovascular-injury-using-computed-tomography-angiography
#7
Michael K Tso, Myunghyun M Lee, Chad G Ball, William F Morrish, Alim P Mitha, Andrew W Kirkpatrick, John H Wong
OBJECTIVE Blunt cerebrovascular injury (BCVI) occurs in approximately 1% of the blunt trauma population and may lead to stroke and death. Early vascular imaging in asymptomatic patients at high risk of having BCVI may lead to earlier diagnosis and possible stroke prevention. The objective of this study was to determine if the implementation of a formalized asymptomatic BCVI screening protocol with CT angiography (CTA) would lead to improved BCVI detection and stroke prevention. METHODS Patients with vascular imaging studies were identified from a prospective trauma registry at a single Level 1 trauma center between 2002 and 2008...
April 22, 2016: Journal of Neurosurgery
https://www.readbyqxmd.com/read/27027559/early-antithrombotic-therapy-is-safe-and-effective-in-patients-with-blunt-cerebrovascular-injury-and-solid-organ-injury-or-traumatic-brain-injury
#8
Charles P Shahan, Louis J Magnotti, Paul B McBeth, Jordan A Weinberg, Martin A Croce, Timothy C Fabian
BACKGROUND: Early antithrombotic therapy (AT) is the mainstay of treatment in the management of blunt cerebrovascular injury (BCVI). Despite this, optimal timing of initiation of AT in patients with BCVI in the presence of concomitant traumatic brain injury (TBI) or solid organ injury (SOI) remains controversial. The purpose of this study was to evaluate the impact of early initiation of AT on outcomes in patients with BCVI and TBI and/or SOI. METHODS: Patients with BCVI and concomitant TBI and/or SOI over 6 years were identified...
July 2016: Journal of Trauma and Acute Care Surgery
https://www.readbyqxmd.com/read/27015579/a-safe-and-effective-management-strategy-for-blunt-cerebrovascular-injury-avoiding-unnecessary-anticoagulation-and-eliminating-stroke
#9
Charles P Shahan, Louis J Magnotti, Shaun M Stickley, Jordan A Weinberg, Leah E Hendrick, Rebecca A Uhlmann, Thomas J Schroeppel, Daniel A Hoit, Martin A Croce, Timothy C Fabian
BACKGROUND: Few injuries have produced as much debate with respect to management as have blunt cerebrovascular injuries (BCVIs). Recent work (American Association for the Surgery of Trauma 2013) from our institution suggested that 64-channel multidetector computed tomographic angiography (CTA) could be the primary screening tool for BCVI. Consequently, our screening algorithm changed from digital subtraction angiography (DSA) to CTA, with DSA reserved for definitive diagnosis of BCVI following CTA-positive study results or unexplained neurologic findings...
June 2016: Journal of Trauma and Acute Care Surgery
https://www.readbyqxmd.com/read/26200995/the-natural-history-of-indeterminate-blunt-cerebrovascular-injury
#10
Jeffrey D Crawford, Kevin M Allan, Karishma U Patel, Kyle D Hart, Martin A Schreiber, Amir F Azarbal, Timothy K Liem, Erica L Mitchell, Gregory L Moneta, Gregory J Landry
IMPORTANCE: The Denver criteria grade blunt cerebrovascular injuries (BCVIs) but fail to capture many patients with indeterminate findings on initial imaging. OBJECTIVE: To evaluate outcomes and clinical significance of indeterminate BCVIs (iBCVIs). DESIGN, SETTING, AND PARTICIPANTS: A retrospective review of all patients treated for BCVIs at our institution from January 1, 2007, through July 31, 2014, was completed. Patients were divided into 2 groups: those with true BCVIs as defined by the Denver criteria and those with iBCVIs, which was any initial imaging suggestive of a cerebrovascular arterial injury not classifiable by the Denver criteria...
September 2015: JAMA Surgery
https://www.readbyqxmd.com/read/26122415/vertebral-artery-transection-in-nonpenetrating-trauma-a-series-of%C3%A2-4%C3%A2-patients
#11
REVIEW
Ezekiel Maloney, Bruce Lehnert, Michael F McNeeley
Blunt cerebrovascular injury is a common and potentially devastating consequence of nonpenetrating trauma to the head and neck. The degree of injury ranges from minimal intimal disruption to complete transection with free extravasation. Although blunt carotid transection has been well characterized in clinical reports and radiologic studies, the computed tomographic angiography (CTA) features of blunt vertebral artery transection have not been well described. We report a series of 4 patients presenting to our level I trauma center with blunt vertebral artery transection, with an emphasis on their CTA imaging findings at presentation and their respective clinical courses...
October 2015: Annals of Vascular Surgery
https://www.readbyqxmd.com/read/26113246/association-between-cervical-spine-and-skull-base-fractures-and-blunt-cerebrovascular-injury
#12
Karen Buch, Thanh Nguyen, Eric Mahoney, Brandon Libby, Paul Calner, Peter Burke, Alex Norbash, Asim Mian
INTRODUCTION: Blunt cerebrovascular injuries (BCVI) are associated with high morbidity and mortality and can lead to neurological deficits. The established criteria for patients undergoing CT angiography (CTA) for BCVI are broad, and can expose patients to radiation unnecessarily. This study aimed to examine the prevalence of BCVI in patients on CTA and determine presentations associated with the highest rates of BCVI. MATERIALS AND METHODS: With IRB approval, patients were selected for CTA screening for BCVI according to a predefined set of criteria at our hospital between 2007 and 2010...
February 2016: European Radiology
https://www.readbyqxmd.com/read/26091318/enoxaparin-ameliorates-post-traumatic-brain-injury-edema-and-neurologic-recovery-reducing-cerebral-leukocyte-endothelial-interactions-and-vessel-permeability-in-vivo
#13
Shengjie Li, Joshua A Marks, Rachel Eisenstadt, Kenichiro Kumasaka, Davoud Samadi, Victoria E Johnson, Daniel N Holena, Steven R Allen, Kevin D Browne, Douglas H Smith, Jose L Pascual
BACKGROUND: Traumatic brain injury (TBI) confers a high risk of venous thrombosis, but early prevention with heparinoids is often withheld, fearing cerebral hematoma expansion. Yet, studies have shown heparinoids not only to be safe but also to limit brain edema and contusion size after TBI. Human TBI data also suggest faster radiologic and clinical neurologic recovery with earlier heparinoid administration. We hypothesized that enoxaparin (ENX) after TBI blunts in vivo leukocyte (LEU) mobilization to injured brain and cerebral edema, while improving neurologic recovery without increasing the size of the cerebral hemorrhagic contusion...
July 2015: Journal of Trauma and Acute Care Surgery
https://www.readbyqxmd.com/read/26067461/initial-screening-test-for-blunt-cerebrovascular-injury-validity-assessment-of-whole-body-computed-tomography
#14
Adriana Laser, Joseph A Kufera, Brandon R Bruns, Clint W Sliker, Ronald B Tesoriero, Thomas M Scalea, Deborah M Stein
INTRODUCTION: Our whole-body computed tomography protocol (WBCT), used to image patients with polytrauma, consists of a noncontrast head computed tomography (CT) followed by a multidetector computed tomography (40- or 64- slice) that includes an intravenous, contrast-enhanced scan from the face through the pelvis. WBCT is used to screen for blunt cerebrovascular injury (BCVI) during initial CT imaging of the patient with polytrauma and allows for early initiation of therapy with the goal of avoiding stroke...
September 2015: Surgery
https://www.readbyqxmd.com/read/25943846/carotid-and-vertebral-injury-study-cavis-technique-for-characterization-of-blunt-traumatic-aneurysms-with-reliability-assessment
#15
Christoph J Griessenauer, Paul Foreman, Mohammadali M Shoja, Kimberly P Kicielinski, John P Deveikis, Beverly C Walters, Mark R Harrigan
Traumatic aneurysms occur in up to 20% of blunt traumatic extracranial carotid artery injuries. Currently there is no standardized method for characterization of traumatic aneurysms. For the carotid and vertebral injury study (CAVIS), a prospective study of traumatic cerebrovascular injury, we established a method for aneurysm characterization and tested its reliability. Saccular aneurysm size was defined as the greatest linear distance between the expected location of the normal artery wall and the outer edge of the aneurysm lumen ("depth")...
April 2015: Interventional Neuroradiology
https://www.readbyqxmd.com/read/25751394/mindin-regulates-vascular-smooth-muscle-cell-phenotype-and-prevents-neointima-formation
#16
Li-Hua Zhu, Ling Huang, Xiaojing Zhang, Peng Zhang, Shu-Min Zhang, Hongjing Guan, Yan Zhang, Xue-Yong Zhu, Song Tian, Keqiong Deng, Hongliang Li
Mindin/spondin 2, an extracellular matrix (ECM) component that belongs to the thrombospondin type 1 (TSR) class of molecules, plays prominent roles in the regulation of inflammatory responses, angiogenesis and metabolic disorders. Our most recent studies indicated that mindin is largely involved in the initiation and development of cardiac and cerebrovascular diseases [Zhu et al. (2014) J. Hepatol. 60, 1046-1054; Bian et al. (2012) J. Mol. Med. 90, 895-910; Wang et al. (2013) Exp. Neurol. 247, 506-516; Yan et al...
July 2015: Clinical Science (1979-)
https://www.readbyqxmd.com/read/25745952/risk-factors-for-traumatic-blunt-cerebrovascular-injury-diagnosed-by-computed-tomography-angiography-in-the-pediatric-population-a-retrospective-cohort-study
#17
Vijay M Ravindra, Jay Riva-Cambrin, Walavan Sivakumar, Ryan R Metzger, Robert J Bollo
OBJECT Computed tomography angiography (CTA) is frequently used to examine patients for blunt cerebrovascular injury (BCVI) after cranial trauma, but the pediatric population at risk for BCVI is poorly defined. Although CTA is effective for BCVI screening in adults, the increased lifetime risk for malignant tumors associated with this screening modality warrants efforts to reduce its use in children. The authors' objective was to evaluate the incidence of BCVI diagnosed by CTA in a pediatric patient cohort and to create a prediction model to identify children at high risk for BCVI...
June 2015: Journal of Neurosurgery. Pediatrics
https://www.readbyqxmd.com/read/25695844/blunt-intraoral-trauma-resulting-in-internal-carotid-artery-dissection-and-infarction-in-a-child
#18
Chris Bent, Peter Shen, Brian Dahlin, Kevin Coulter
A 16-month-old child fell forward onto her toothbrush sustaining minor oropharyngeal injury. The following day, she became acutely lethargic with localizing neurologic signs of a cerebrovascular infarct. CTA and MR imaging demonstrated occlusion of the right internal carotid artery with a large right middle cerebral artery territory infarction. She was treated with decompressive craniectomy and anticoagulation but remained weak on the left side. Pediatric oropharyngeal injuries can rarely be complicated by internal carotid artery injury with dissection, thrombosis, or embolization to the cerebral circulation...
August 2016: Pediatric Emergency Care
https://www.readbyqxmd.com/read/25527626/traumatic-brain-injury-disrupts-cerebrovascular-tone-through-endothelial-inducible-nitric-oxide-synthase-expression-and-nitric-oxide-gain-of-function
#19
Nuria Villalba, Swapnil K Sonkusare, Thomas A Longden, Tram L Tran, Adrian M Sackheim, Mark T Nelson, George C Wellman, Kalev Freeman
BACKGROUND: Traumatic brain injury (TBI) has been reported to increase the concentration of nitric oxide (NO) in the brain and can lead to loss of cerebrovascular tone; however, the sources, amounts, and consequences of excess NO on the cerebral vasculature are unknown. Our objective was to elucidate the mechanism of decreased cerebral artery tone after TBI. METHODS AND RESULTS: Cerebral arteries were isolated from rats 24 hours after moderate fluid‐percussion TBI...
December 2014: Journal of the American Heart Association
https://www.readbyqxmd.com/read/25526279/clinical-and-radiographic-outcomes-following-traumatic-grade-3-and-4-carotid-artery-injuries-a-10-year-retrospective-analysis-from-a-level-1-trauma-center-the-parkland-carotid-and-vertebral-artery-injury-survey
#20
William W Scott, Steven Sharp, Stephen A Figueroa, Alexander L Eastman, Charles V Hatchette, Christopher J Madden, Kim L Rickert
OBJECT: Screening, management, and follow-up of Grade 3 and 4 blunt carotid artery injuries (BCAIs) remain controversial. These high-grade BCAIs were analyzed to define their natural history and establish a rational management plan based on lesion progression and cerebral infarction. METHODS: A retrospective review of a prospectively maintained database of all blunt traumatic carotid and vertebral artery injuries from August 2003 to April 2013 was performed, and Grade 3 and 4 BCAIs were identified...
March 2015: Journal of Neurosurgery
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