Western Trauma Association Critical Decisions in Trauma:
Screening for and Treatment of Blunt Cerebrovascular Injuries
J Trauma. Volume 67(6), December 2009, pp 1150-1153
Signs/Symptoms of BCVI
- Arterial hemorrhage from neck, mouth, nose
- Large or expanding cervical hematoma
- Cervical bruit in a patient younger than 50 years
- Focal or lateralizing neurologic deficit, including hemiparesis, TIA, Horner’s syndrome, oculosympathetic paresis, or VBI
- Evidence of cerebral infarction on CT or MRI
- Neurologic deficit that is incongruous with CT
Risk Factors for BCVI
- An injury mechanism compatible with severe cervical hyper-extension with rotation or hyper-flexion
- Lefort II or III midface fractures
- Basilar skull fracture involving the carotid canal
- Closed head injury consistent with DAI with GCS <6
- Cervical vertebral body or transverse foramen fracture, subluxation, or ligamentous injury at any level, or any fracture at the level of C1–C3
- Near-hanging resulting in cerebral anoxia
- Seat belt or other clothesline-type injury with significant cervical pain, swelling, or AMS
Diagnosis and Management of Blunt Carotid and Vertebral Vascular Injuries
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