BLUNT AND PENETRATING CEREBROVASCULAR INJURIES: PEARLS AND PITFALLS

Authors: Colbey Taylor, Jacques Van Heerden, Savvas Nicolaou, Nicolas Murray

Level of training: Resident 

Institutional Affiliation: University of British Columbia 

LEARNING OBJECTIVES:
To review the classification of blunt cerebrovascular injuries 
To discuss the appropriate use of CT angiogram (CTA) head and neck based on mechanism of injury
To recognize the radiological manifestations of cerebrovascular injuries and their outcomes
To describe normal variants that can mimic cerebrovascular injuries 

BACKGROUND: Blunt and penetrating cerebrovascular injuries are rare, but potentially life threatening, with an incidence between 1-3% of trauma admission. Untreated, carotid and vertebral artery injuries have been associated with mortality rates up to 38% and 18% respectively. CTA is currently the “gold standard” for detection and classification of cerebrovascular injuries considering its availability and rapidity of acquisition. It is essential for radiologists to understand the indications for vascular imaging based on the mechanisms of injury, preliminary imaging findings and clinical features. Early and accurate injury identification, and classification, are essential for developing treatment plans aimed at reducing the incidence of post-injury ischemic stroke and mortality. 

CONCLUSION: Identification and classification of blunt and penetrating cerebrovascular injuries is important for the practicing radiologist, as imaging findings often dictate the treatment plans and outcomes of the patients.