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Blunt injury on cerebrovascular

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https://www.readbyqxmd.com/read/28886695/cerebral-microvascular-dysfunction-in-metabolic-syndrome-is-exacerbated-by-ischemia-reperfusion-injury
#1
Nathalie Obadia, Marcos Adriano Lessa, Anissa Daliry, Raquel Rangel Silvares, Fabiana Gomes, Eduardo Tibiriçá, Vanessa Estato
BACKGROUND: Metabolic syndrome (MetS) is associated with an increased risk of cerebrovascular diseases, including cerebral ischemia. Microvascular dysfunction is an important feature underlying the pathophysiology of cerebrovascular diseases. In this study, we aimed to investigate the impacts of ischemia and reperfusion (IR) injury on the cerebral microvascular function of rats with high-fat diet-induced MetS. RESULTS: We examined Wistar rats fed a high-fat diet (HFD) or normal diet (CTL) for 20 weeks underwent 30 min of bilateral carotid artery occlusion followed by 1 h of reperfusion (IR) or sham surgery...
September 8, 2017: BMC Neuroscience
https://www.readbyqxmd.com/read/28877048/current-opinion-in-otolaryngology-update-on-vascular-injuries-in-craniomaxillofacial-fractures
#2
Elisa Illing, Sarah Jo Burgin, Cecelia E Schmalbach
PURPOSE OF REVIEW: The primary purpose of this chapter is to define current recommendations for vascular work-up of patients with craniomaxillofacial (CMF) trauma with emphasis on imaging to include intraoperative fluorescence, angiography, and surgical exploration. The second goal is to review current management recommendations for observation versus surgical exploration based on the neck zones of injury. RECENT FINDINGS: Over the past two decades, endovascular techniques are increasingly utilized, particularly in zones I and III of the neck...
September 4, 2017: Current Opinion in Otolaryngology & Head and Neck Surgery
https://www.readbyqxmd.com/read/28799874/limitations-of-multidetector-computed-tomography-angiography-for-the-diagnosis-of-blunt-cerebrovascular-injury
#3
Ramesh Grandhi, Gregory M Weiner, Nitin Agarwal, David M Panczykowski, William J Ares, Jesse S Rodriguez, Jonathan A Gelfond, John G Myers, Louis H Alarcon, David O Okonkwo, Brian T Jankowitz
OBJECTIVE Blunt cerebrovascular injuries (BCVIs) following trauma carry risk for morbidity and mortality. Since patients with BCVI are often asymptomatic at presentation and neurological sequelae often occur within 72 hours, timely diagnosis is essential. Multidetector CT angiography (CTA) has been shown to be a noninvasive, cost-effective, reliable means of screening; however, the false-positive rate of CTA in diagnosing patients with BCVI represents a key drawback. Therefore, the authors assessed the role of DSA in the screening of BCVI when utilizing CTA as the initial screening modality...
August 11, 2017: Journal of Neurosurgery
https://www.readbyqxmd.com/read/28686114/erratum-reliability-assessment-of-the-biffl-scale-for-blunt-traumatic-cerebrovascular-injury-as-detected-on-computer-tomography-angiography
#4
Paul M Foreman
No abstract text is available yet for this article.
July 7, 2017: Journal of Neurosurgery
https://www.readbyqxmd.com/read/28674346/diagnosis-and-treatment-of-traumatic-cerebrovascular-injury-pitfalls-in-the-management-of-neurotrauma
#5
Hitoshi Kobata
Traumatic cerebrovascular injury (TCVI) is an uncommon clinical entity in traumatic brain injury (TBI), yet it may cause devastating brain injury with high morbidity and mortality. Early recognition and prioritized strategic treatment are of paramount importance. A total of 1966 TBI patients admitted between 1999 and 2015 in our tertiary critical care center were reviewed. Screening of TCVI was based on the Guidelines for the Management of Severe Head Injury in Japan. TCVI was confirmed in 33 (1.7%) patients; 29 blunt and 4 penetrating injuries...
August 15, 2017: Neurologia Medico-chirurgica
https://www.readbyqxmd.com/read/28640778/a-cohort-study-of-blunt-cerebrovascular-injury-screening-in-children-are-they-just-little-adults
#6
Mackenzie R Cook, Cordelie E Witt, Robert H Bonow, Eileen M Bulger, Ken F Linnau, Saman Arbabi, Bryce R H Robinson, Joseph Cuschieri
BACKGROUND: Blunt cerebrovascular injuries (BCVI) are rare with nonspecific predictors, making optimal screening critical. Radiation concerns magnify these issues in children. The Eastern Association for the Surgery of Trauma (EAST) criteria, the Utah score (US) and the Denver criteria (DC) have been advocated for pediatric BCVI screening, though direct comparison is lacking. We hypothesized that current screening guidelines inaccurately identify pediatric BCVI. METHODS: This was a retrospective cohort study of pediatric trauma patients treated from 2005-2015 with radiographically confirmed BCVI...
June 20, 2017: Journal of Trauma and Acute Care Surgery
https://www.readbyqxmd.com/read/28383858/-blunt-cerebrovascular-injury
#7
P Bouchat, F Pitance, F Damas, L Trippaerts
A blunt cerebrovascular injury (BCVI) can cause severe cerebral ischemic sequelae. The diagnosis is tricky and often entails a latency period. Adequate treatment at this time will dramatically reduce mortality and morbidity. The Denver protocol guides the selection of the patients to be screened. Current treatment is based on heparin, anticoagulant antiplatelet drugs, interventional radiology and surgery. The treatment is based on a dynamic strategy.
June 2016: Revue Médicale de Liège
https://www.readbyqxmd.com/read/28302280/blunt-cerebrovascular-injury-in-children
#8
REVIEW
Stephen J Fenton, Robert J Bollo
Blunt cerebrovascular injury in children is an uncommon occurrence that if missed and left untreated can result in devastating long-term neurologic consequences. Diagnosis can be readily obtained by a computed tomographic angiogram of the head and neck. If confirmed, treatment with antithrombotic therapy dramatically reduces the risk of a cerebrovascular accident. The difficulty lies in determining which child should be screened for such an injury. Several institutions have come up with criteria for screening...
February 2017: Seminars in Pediatric Surgery
https://www.readbyqxmd.com/read/28111193/impact-of-continuous-evaluation-of-technology-and-therapy-30-years-of-research-reduces-stroke-and-mortality-from-blunt-cerebrovascular-injury
#9
Charles P Shahan, Martin A Croce, Timothy C Fabian, Louis J Magnotti
BACKGROUND: Blunt cerebrovascular injury (BCVI) was underdiagnosed until the 1990s when blunt carotid injuries were found to be more common than historically described. Technological advancements and regionalization of trauma care have resulted in increased screening and improved diagnosis of BCVI. The aim of this study was to demonstrate that systematic evaluation of the screening and diagnosis of BCVI, combined with early and aggressive treatment, have led to reductions in BCVI-related stroke and mortality...
April 2017: Journal of the American College of Surgeons
https://www.readbyqxmd.com/read/27979639/the-use-of-high-risk-criteria-in-screening-patients-for-blunt-cerebrovascular-injury-a-survey
#10
Xiao Wu, Ajay Malhotra, Howard P Forman, Diego Nunez, Pina Sanelli
RATIONALE AND OBJECTIVES: Blunt cerebrovascular injury (BCVI) is uncommon, but delayed detection can have disastrous consequences. The Denver criteria are the most commonly used screening criteria. We aim to examine the utilization of screening criteria in the emergency department (ED) of our institution and assess whether patients with risk factors were imaged. MATERIALS AND METHODS: A survey questionnaire was sent out to radiologists in a large academic institution...
December 12, 2016: Academic Radiology
https://www.readbyqxmd.com/read/27781188/blunt-cerebrovascular-injury-in-cervical-spine-fractures-are-more-liberal-screening-criteria-warranted
#11
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
#12
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...
July 2017: Journal of Neurosurgery
https://www.readbyqxmd.com/read/27751528/expanded-screening-criteria-for-blunt-cerebrovascular-injury-a-bigger-impact-than-anticipated
#13
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...
December 2016: American Journal of Surgery
https://www.readbyqxmd.com/read/27537517/long-term-follow-up-of-blunt-cerebrovascular-injuries-does-time-heal-all-wounds
#14
Adriana Laser, Brandon R Bruns, Joseph A Kufera, Andrew I 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 (BCVIs) has been previously described in the literature, but the purpose of this study was 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 with a diagnosis of BCVI by computed tomographic (CT) scan were identified, and injuries were graded based on modified Denver scale...
December 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
#15
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
#16
Vijay M Ravindra, Robert J Bollo, Walavan Sivakumar, Hassan Akbari, Robert P Naftel, David D Limbrick, Andrew Jea, Stephen Gannon, Chevis Shannon, Yekaterina Birkas, George L Yang, Colin T Prather, John R 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 I trauma centers...
January 15, 2017: Journal of Neurotrauma
https://www.readbyqxmd.com/read/27104846/clinical-utility-of-a-screening-protocol-for-blunt-cerebrovascular-injury-using-computed-tomography-angiography
#17
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 2017: 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
#18
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
#19
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
#20
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
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