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blunt cerebrovascular injuries

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https://www.readbyqxmd.com/read/29884478/blunt-cerebrovascular-injury-incidence-stroke-rate-and-mortality-with-the-expanded-denver-criteria
#1
Areg Grigorian, Nii-Kabu Kabutey, Sebastian Schubl, Christian de Virgilio, Victor Joe, Matthew Dolich, Dawn Elfenbein, Jeffry Nahmias
BACKGROUND: Blunt carotid and vertebral artery injury, collectively termed blunt cerebrovascular injury occur in less than 1% of blunt traumas. Conventional indications for screening miss up to 20% of blunt cerebrovascular injuries. Therefore, the expanded Denver criteria were created in 2012. We hypothesized the introduction of the expanded Denver criteria would lead to an increase in the national detection of blunt cerebrovascular injury with a subsequent decrease in stroke rate. METHODS: The National Trauma Data Bank was queried for blunt trauma admissions...
June 5, 2018: Surgery
https://www.readbyqxmd.com/read/29847537/time-to-stroke-a-western-trauma-association-multi-center-study-of-blunt-cerebrovascular-injuries
#2
Clay Cothren Burlew, Joshua J Sumislawski, Charles D Behnfield, Michelle K McNutt, James McCarthy, John P Sharpe, Martin A Croce, Miklosh Bala, Jeffry Kashuk, M Chance Spalding, Paul R Beery, Scott John, Darren J Hunt, Laura Harmon, Deborah M Stein, Rachael Callcut, Chris Wybourn, Jason Sperry, Vincent Anto, Julie Dunn, Jacob P Veith, Carlos V R Brown, Amanda Celii, Tyler L Zander, Raul Coimbra, Allison E Berndtson, Tovah Z Moss, Ajai K Malhotra, Joshua P Hazelton, Kimberly Linden, Michaela West, Hasan B Alam, Aaron M Williams, Jennie Kim, Kenji Inaba, Steve Moulton, Young Mee Choi, Harry L Warren, Bryan Collier, Chad G Ball, Stephanie Savage, Jennifer L Hartwell, Daniel C Cullinane, Martin D Zielinski, Mohamed D Ray-Zack, Bryan C Morse, Peter Rhee, Edmund J Rutherford, Pascal Udekwu, Cassandra Reynolds, Eric Toschlog, Steve Gondek, Tammy Ju, James M Haan, Kelly L Lightwine, Narong Kulvatunyou, Brian Coates, Ahmed F Khouqeer, S Rob Todd, Ben Zarzaur, Christine J Waller, Kara J Kallies, Todd Neideen, Savo Bou Zein Eddine, Kimberly A Peck, Casey E Dunne, Kristina Kramer, Faran Bokhari, Tejveer S Dhillon, Joseph M Galante, Mitchell J Cohen
BACKGROUND: Screening for blunt cerebrovascular injuries (BCVI) in asymptomatic high-risk patients has become routine. To date, the length of this asymptomatic period has not been defined. Determining the time to stroke could impact therapy including earlier initiation of antithrombotics in multiply injured patients. The purpose of this study is to determine the time to stroke in patients with a BCVI-related stroke. We hypothesized the majority of patients suffer stroke between 24-72 hours after injury...
May 25, 2018: Journal of Trauma and Acute Care Surgery
https://www.readbyqxmd.com/read/29775142/aspirin-for-primary-prevention-of-stroke-in-traumatic-cerebrovascular-injury-association-with-increased-risk-of-transfusion
#3
Russell L Griffin, Stephanie R Falatko, Stella Aslibekyan, Virginia Strickland, Mark R Harrigan
OBJECTIVE Blunt traumatic extracranial carotid or vertebral artery injury (i.e., traumatic cerebrovascular injury [TCVI]) occurs in 1%-2% of all blunt trauma admissions, carries a 10% risk of thromboembolic ischemic stroke, and accounts for up to 9600 strokes annually in the US. Screening CT angiograms (CTAs) of patients with trauma has become ubiquitous in recent years, and patients with initially asymptomatic TCVI are commonly treated with antiplatelet agents to prevent stroke. Prophylaxis with antiplatelets is thought to be safer than anticoagulation, which carries a significant risk of hemorrhage in patients with trauma...
May 18, 2018: Journal of Neurosurgery
https://www.readbyqxmd.com/read/29749913/letter-to-the-editor-computed-tomography-angiography-for-the-diagnosis-of-blunt-cerebrovascular-injury
#4
Ajay Malhotra, Xiao Wu, Long Tu, Kimberly Seifert
No abstract text is available yet for this article.
May 11, 2018: Journal of Neurosurgery
https://www.readbyqxmd.com/read/29712605/long-term-functional-outcomes-after-blunt-cerebrovascular-injury-a-20-year-experience
#5
Charles P Shahan, Taylor C Stavely, Martin A Croce, Timothy C Fabian, Louis J Magnotti
Since blunt cerebrovascular injury (BCVI) became increasingly recognized more than 20 years ago, significant improvements have been made in both diagnosis and treatment. Little is known regarding long-term functional outcomes in BCVI. The purpose of this study was to evaluate the impact of BCVI on those long-term outcomes. All patients with BCVI from 1996 to 2014 were identified from the trauma registry. Functional outcome was measured using the Boston University Activity Measure for Post-Acute Care. Multiple regression analysis was performed to identify potential predictors of outcomes...
April 1, 2018: American Surgeon
https://www.readbyqxmd.com/read/29685471/the-age-of-undertriage-current-trauma-triage-criteria-underestimate-the-role-of-age-and-comorbidities-in-early-mortality
#6
Elizabeth R Benjamin, Desmond Khor, Jayun Cho, Subarna Biswas, Kenji Inaba, Demetrios Demetriades
BACKGROUND: National guidelines recommend that prehospital and emergency department (ED) criteria identify patients who might benefit from trauma center triage and highest-level trauma team activation. However, some patients who are seemingly "stable" in the field and do not meet the standard criteria for trauma activation still die. OBJECTIVES: The purpose of this study was to identify these at-risk patients to potentially improve triage algorithms. METHODS: Patients enrolled in the National Trauma Data Bank (2007-2012) were included...
April 19, 2018: Journal of Emergency Medicine
https://www.readbyqxmd.com/read/29679584/remember-the-vessels-craniofacial-fracture-predicts-risk-for-blunt-cerebrovascular-injury
#7
Elina Varjonen, Frank Bensch, Tuomo Pyhältö, Mika Koivikko, Johanna Snäll
PURPOSE: The risk factors for blunt cerebrovascular injuries (BCVIs) are currently under intensive research, yet it is still controversial who should be screened. This study aimed to determine whether craniofacial fractures are associated with BCVI. PATIENTS AND METHODS: This retrospective cohort study focused on patients with suspected polytrauma after whole-body computed tomographic angiography of the cervical arteries. Patients were reviewed for BCVI and craniofacial fractures...
March 28, 2018: Journal of Oral and Maxillofacial Surgery
https://www.readbyqxmd.com/read/29547069/pediatric-blunt-cerebrovascular-injury-the-mcgovern-screening-score
#8
Joseph P Herbert, Sidish S Venkataraman, Ali H Turkmani, Liang Zhu, Marcia L Kerr, Rajan P Patel, Irma T Ugalde, Stephen A Fletcher, David I Sandberg, Charles S Cox, Ryan S Kitagawa, Arthur L Day, Manish N Shah
OBJECTIVE The objective of this study was to assess the incidence, diagnosis, and treatment of pediatric blunt cerebrovascular injury (BCVI) at a busy Level 1 trauma center and to develop a tool for accurately predicting pediatric BCVI and the need for diagnostic testing. METHODS This is a retrospective cohort study of a prospectively collected database of pediatric patients who had sustained blunt trauma (patient age range 0-15 years) and were treated at a Level 1 trauma center between 2005 and 2015. Digital subtraction angiography, MR angiography, or CT angiography was used to confirm BCVI...
March 16, 2018: Journal of Neurosurgery. Pediatrics
https://www.readbyqxmd.com/read/29528828/imaging-and-management-of-blunt-cerebrovascular-injury
#9
Aaron M Rutman, Justin E Vranic, Mahmud Mossa-Basha
Blunt cerebrovascular injury (BCVI) is a relatively rare but potentially devastating finding in patients with high-energy blunt force trauma or direct cervical and/or craniofacial injury. The radiologist plays an essential role in identifying and grading the various types of vascular injury, including minimal intimal injury, dissection with raised intimal flap or intraluminal thrombus, intramural hematoma, pseudoaneurysm, occlusion, transection, and arteriovenous fistula. Early identification of BCVI is important, as treatment with antithrombotic therapy has been shown to reduce the incidence of postinjury ischemic stroke...
March 2018: Radiographics: a Review Publication of the Radiological Society of North America, Inc
https://www.readbyqxmd.com/read/29497851/resolution-of-traumatic-bilateral-vertebral-artery-injury
#10
REVIEW
Yutaka Igarashi, Takahiro Kanaya, Shoji Yokobori, Takeshi Tsukamoto, Hiroyuki Yokota
PURPOSE: Cerebrovascular ischaemia is a rare but serious complication of damage to the carotid or vertebral arteries in the neck caused by blunt injury to the neck. Screening for blunt cerebrovascular injury should be performed in patients with certain signs or symptoms and risk factors. We described a case of traumatic bilateral vertebral artery injury (VAI) including unilateral vertebral arterial occlusion that resolved 3 months post-injury with antiplatelet and direct oral anticoagulant therapy...
March 1, 2018: European Spine Journal
https://www.readbyqxmd.com/read/29478119/a-review-of-split-bolus-single-pass-ct-in-the-assessment-of-trauma-patients
#11
Cassandra Jeavons, Craig Hacking, Ludo F Beenen, Martin L Gunn
PURPOSE: The purpose of this study was to review and compare the image quality and radiation dose of split-bolus single-pass computed tomography(CT) in the assessment of trauma patients in comparison to standard multi-phase CT techniques. METHODS: An online electronic database was searched using the MESH terms "split-bolus," "dual phase," and "single pass." Inclusion criteria required the research article to compare a split contrast bolus protocol in a single-pass scan in the assessment of trauma patients...
February 24, 2018: Emergency Radiology
https://www.readbyqxmd.com/read/29370049/the-changing-role-of-endovascular-stenting-for-blunt-cerebrovascular-injuries
#12
Charles P Shahan, John P Sharpe, Shaun M Stickley, Nate R Manley, Dina M Filiberto, Timothy C Fabian, Martin A Croce, Louis J Magnotti
BACKGROUND: Few injuries have produced as much debate with respect to management as have blunt cerebrovascular injuries (BCVIs). Without question, early anticoagulation is the mainstay of therapy for these injuries. However, the role of endovascular stenting for BCVI remains controversial. Our purpose was to examine the use of endovascular stents for BCVI and outcomes and describe which injuries are being treated with stents. METHODS: Patients with BCVI from 2011 to 2016 were identified and stratified by age, sex, and injury severity...
February 2018: Journal of Trauma and Acute Care Surgery
https://www.readbyqxmd.com/read/29137056/optic-nerve-injury-associated-blunt-cerebrovascular-injury-three-case-reports
#13
Dan-Dong Li, Liu-Xun Hu, Linyuan Sima, Shang-Yu Xu, Jian Lin, Nu Zhang, Bo Yin
RATIONALE: Blunt cerebrovascular injury (BCVI) is a rare complication that may occur after craniocervical trauma. The current literature is limited to extracranial carotid artery injuries; however, no reports have been published on blunt intracranial carotid injury (BICI), especially those associated with optic nerve injury. PATIENT CONCERNS: Here we report on 3 BICI cases that demonstrated optic nerve injuries after craniofacial injuries. All 3 patients showed post-trauma vision loss on the injured side...
November 2017: Medicine (Baltimore)
https://www.readbyqxmd.com/read/29123850/delayed-massive-epistaxis-from-traumatic-intracranial-aneurysm-after-blunt-facial-injury
#14
Hajime Nakamura, Toshiyuki Fujinaka, Osamu Tasaki, Toshiki Yoshimine
Cases: Traumatic intracranial aneurysm following blunt head injury is uncommon but can be induced by extension of skull base fracture and causes unexpected hemorrhagic complications. We present two cases of traumatic intracranial aneurysm in the paraclinoid area that was revealed by delayed massive epistaxis. Lack of initial neurological deficits omitted screening for cerebrovascular injury. Outcome: Internal trapping was carried out using endovascular techniques in both cases, with extracranial-intracranial bypass in one case...
January 2017: Acute Medicine & Surgery
https://www.readbyqxmd.com/read/29108846/predictors-of-pediatric-blunt-cerebrovascular-injury
#15
Avery C Rossidis, Sasha J Tharakan, Sourav K Bose, Karuna V Shekdar, Michael L Nance, Thane A Blinman
BACKGROUND/PURPOSE: Blunt cerebrovascular injury (BCVI) is clinically challenging because these injuries are hard to detect and can have serious neurological consequences, and optimal screening criteria have not been established for children. This study aims to determine risk factors for BCVI in pediatric patients and to evaluate screening practices in a single institutional series. METHODS: A retrospective review of all pediatric blunt trauma patients evaluated over a 10-year period was performed...
October 12, 2017: Journal of Pediatric Surgery
https://www.readbyqxmd.com/read/29027732/blunt-cerebrovascular-injury-early-recognition-and-treatment-options-in-asymptomatic-patient
#16
Alexander Becker, Dror Ashkenazi, Dan Hershko
No abstract text is available yet for this article.
October 13, 2017: ANZ Journal of Surgery
https://www.readbyqxmd.com/read/29025722/blunt-cerebrovascular-injuries-advances-in-screening-imaging-and-management-trends
#17
REVIEW
P Nagpal, B A Policeni, G Bathla, A Khandelwal, C Derdeyn, D Skeete
Blunt cerebrovascular injury is a relatively uncommon but sometimes life-threatening injury, particularly in patients presenting with ischemic symptoms in that vascular territory. The decision to pursue vascular imaging (generally CT angiography) is based on clinical and imaging findings. Several grading scales or screening criteria have been developed to guide the decision to pursue vascular imaging, as well as to recommend different treatment options for various injuries. The data supporting many of these guidelines and options are limited however...
October 12, 2017: AJNR. American Journal of Neuroradiology
https://www.readbyqxmd.com/read/28922275/indications-for-ct-angiography-of-the-vertebral-arteries-after-trauma
#18
Joseph P Drain, Douglas S Weinberg, James S Ramey, Timothy A Moore, Heather A Vallier
STUDY DESIGN: Retrospective. OBJECTIVE: The purpose of this project is to identify factors that predict vertebral artery injury (VAI) in an effort to assess risks and benefits of computed tomography angiography (CT-A) of the neck in the trauma setting. We seek to develop guidelines for practitioners to stratify patients at medium/high risk of VAI from those who are at low risk. SUMMARY OF BACKGROUND DATA: VAI and blunt carotid injury (BCI) together comprise blunt cerebrovascular injury (BCVI)...
May 1, 2018: Spine
https://www.readbyqxmd.com/read/28886695/cerebral-microvascular-dysfunction-in-metabolic-syndrome-is-exacerbated-by-ischemia-reperfusion-injury
#19
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
#20
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...
December 2017: Current Opinion in Otolaryngology & Head and Neck Surgery
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