RESEARCH ARTICLE


The Role of Neuroimaging in the Latent Period of Blunt Traumatic Cerebrovascular Injury



Rahul Karamchandani 1, Venkatakrishna Rajajee*, 2, Aditya Pandey 3
1 Department of Neurology, University of Michigan, Ann Arbor, MI, USA
2 Departments of Neurosurgery and Neurology, University of Michigan, Ann Arbor, MI, USA
3 Department of Neurosurgery, University of Michigan, Ann Arbor, MI, USA


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© Karamchandani et al; Licensee Bentham Open

open-access license: This is an open access article licensed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/), which permits unrestricted, non-commercial use, distribution and reproduction in any medium, provided the work is properly cited.

* Address correspondence to this author at the Department of Neurosurgery, University of Michigan, 3552 Taubman Health Care Center, SPC 5338, 1500 E. Medical Center Drive, Ann Arbor, MI 48109, USA; Tel: (734) 478-9487; Fax: (801) 640-9886; E-mail: vrajajee@yahoo.com


Abstract

Introduction:

Blunt cerebrovascular injury (BCVI) is found in 1-2.7% of all blunt trauma when appropriate screening criteria are employed. A significant number of patients with BCVI have a latent, or asymptomatic period, in which therapeutic intervention based on the appropriate use of angiographic imaging may decrease the risk of an ischemic stroke.

Methods:

Case report and review of literature.

Results:

A 42 year old woman suffered a fall off a motorcycle and was neurologically intact in the emergency room. Fractures involving the transverse foramen of cervical vertebrae were found on non-contrast Computed Tomography (CT) but screening for BCVI with angiographic imaging not performed. She subsequently suffered an ischemic stroke resulting in significant disability. Published studies that address the use of screening criteria for BCVI and subsequent management are reviewed.

Conclusion:

BCVI results in significant morbidity and mortality attributable to ischemic stroke. There is often a latent period between BCVI and occurrence of ischemic stroke. Specific risk factors can be used to identify patients requiring screening with catheter or CT angiography. Treatment with antithrombotic agents is the mainstay of treatment of BCVI and may reduce the rate of ischemic stroke. Identification and treatment of asymptomatic BCVI in blunt trauma patients may prevent ischemic stroke in a predominantly young population.

Keywords: Cerebrovascular trauma, craniocerebral trauma, spinal injuries, carotid artery diseases, brain ischemia.