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blunt cerebrovascular injuries

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
C Patrick Shahan, Louis J Magnotti, Timothy C Fabian
No abstract text is available yet for this article.
October 25, 2016: Journal of Trauma and Acute Care Surgery
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
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
Brian C Dahlin, Ben Waldau
Vascular trauma is associated with blunt skull base fractures and penetrating injuries. We review the contemporary management of cranial vascular trauma, including blunt and penetrating cerebrovascular injury as well as refractory epistaxis from facial trauma.
October 2016: Journal of Neurological Surgery. Part B, Skull Base
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
Vin Shen Ban, James A Botros, Christopher J Madden, H Hunt Batjer
PURPOSE OF REVIEW: Athletic neurosurgical emergencies are injuries that can lead to mortality or significant morbidity and require immediate recognition and treatment. This review article discusses the epidemiology of sports-related traumatic brain injury (TBI) with an attempt to quantify the incidence of neurosurgical emergencies in sports. Emergencies such as intracranial hemorrhage, second impact syndrome, vascular injuries, and seizures are discussed. RECENT FINDINGS: The incidence of sports-related TBI presenting to level I or II trauma centers in the USA is about 10 in 100,000 population per year...
September 2016: Current Pain and Headache Reports
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 following 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...
August 16, 2016: Journal of Trauma and Acute Care Surgery
Pierre Esnault, Mickaël Cardinale, Henry Boret, Erwan D'Aranda, Ambroise Montcriol, Julien Bordes, Bertrand Prunet, Christophe Joubert, Arnaud Dagain, Philippe Goutorbe, Eric Kaiser, Eric Meaudre
OBJECTIVE Blunt cerebrovascular injuries (BCVIs) affect approximately 1% of patients with blunt trauma. An antithrombotic or anticoagulation therapy is recommended to prevent the occurrence or recurrence of neurovascular events. This treatment has to be carefully considered after severe traumatic brain injury (TBI), due to the risk of intracranial hemorrhage expansion. Thus, the physician in charge of the patient is confronted with a hemorrhagic and ischemic risk. The main objective of this study was to determine the incidence of BCVI after severe TBI...
July 29, 2016: Journal of Neurosurgery
Michael C Dewan, Vijay M Ravindra, Stephen Gannon, Colin T Prather, George L Yang, Lori C Jordan, David Limbrick, Andrew Jea, Jay Riva-Cambrin, Robert P Naftel
BACKGROUND: Pediatric blunt cerebrovascular injury (BCVI) lacks accepted treatment algorithms, and postinjury outcomes are ill defined. OBJECTIVE: To compare treatment practices among pediatric trauma centers and to describe outcomes for available treatment modalities. METHODS: Clinical and radiographic data were collected from a patient cohort with BCVI between 2003 and 2013 at 4 academic pediatric trauma centers. RESULTS: Among 645 pediatric patients evaluated with computed tomography angiography for BCVI, 57 vascular injuries (82% carotid artery, 18% vertebral artery) were diagnosed in 52 patients...
July 25, 2016: Neurosurgery
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
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
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
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
Keith Kerr, Christopher Wilkerson, Scott Shepard, HuiMahn Choi, Ryan Kitagawa
OBJECTIVE: To evaluate the risk of hemorrhagic complications associated with starting anti-platelet therapy (APT) after acute traumatic intracranial hemorrhage (tICH) and to examine the frequency of thrombotic complications. PATIENTS AND METHODS: We retrospectively identified all patients admitted to our institution with tICH that received APT during their initial hospitalization over a three-year period. We reviewed their demographics, hospital course, clinical indication and timing for initiation of APT, and complications...
January 2016: Clinical Neurology and Neurosurgery
Ajay Malhotra, Xiao Wu, Vivek B Kalra, Thomas R Goodman, Joseph Schindler, Howard P Forman
BACKGROUND: Timely and accurate screening for pediatric blunt cerebrovascular injury (BCVI) is important in order to administer appropriate anticoagulation therapy thus preventing stroke. The recommended criteria for screening in children are not clear. We performed a systematic review of the literature for screening and management of BCVI in children and designed a cost-effectiveness analysis in order to determine the optimal strategy for managing pediatric BCVI from a societal perspective...
October 2015: Journal of Pediatric Surgery
A Malhotra, X Wu, V B Kalra, J Schindler, C C Matouk, H P Forman
BACKGROUND AND PURPOSE: Evaluation for blunt cerebrovascular injury has generated immense controversy with wide variations in recommendations regarding the need for evaluation and the optimal imaging technique. We review the literature and determine the most cost-effective strategy for evaluating blunt cerebrovascular injury in trauma patients. MATERIALS AND METHODS: A comprehensive literature review was performed with data extracted to create a decision-tree analysis for 5 different strategies: anticoagulation for high-risk (based on the Denver screening criteria) patients, selective DSA or CTA (only high-risk patients), and DSA or CTA for all trauma patients...
February 2016: AJNR. American Journal of Neuroradiology
Lewis E Jacobson, Mary Ziemba-Davis, Argenis J Herrera
INTRODUCTION: Blunt cerebrovascular injury (BCVI) is reported to occur in 1-2 % of blunt trauma patients. Clinical and radiologic risk factors for BCVI have been described to help identify patients that require screening for these injuries. However, recent studies have suggested that BCVI frequently occurs even in the absence of these risk factors. The purpose of this study was to determine the incidence of BCVI in blunt trauma patients without risk factors and whether these patients could be identified by a more liberal CTA screening protocol...
2015: World Journal of Emergency Surgery: WJES
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
Ebony Washington Remus, Iqbal Sayeed, Soonmi Won, Alicia N Lyle, Donald G Stein
The neuroprotective effects of progesterone after ischemic stroke have been established, but the role of progesterone in promoting cerebrovascular repair remains under-explored. Male Sprague-Dawley rats underwent transient middle cerebral artery occlusion (tMCAO) for 90 min followed by reperfusion for 3 days. Progesterone (8 mg/kg/day) was administered intraperitoneally at 1h after initial occlusion followed by subcutaneous injections at 6, 24 and 48 h post-occlusion. Rats were euthanized after 72 h and brain endothelial cell density and macrophage infiltration were evaluated within the cerebral cortex...
September 2015: Experimental Neurology
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