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Cerebrovascular Complications in Early Survivors of Civilian Penetrating Brain Injury

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Abstract

Background

This study investigates the presence of cerebrovascular injuries in a large sample of civilian penetrating brain injury (PBI) patients, determining the prevalence, radiographic characteristics, and impact on short-term outcome.

Methods

We retrospectively reviewed patients with PBI admitted to our institution over a 2-year period. Computed tomography head scans, computer tomography angiograms and venograms of the intracranial vessels were evaluated to determine the wound trajectory, intracranial injury characteristics, and presence of arterial (AI) and venous sinus (VSI) injuries. Demographics, clinical presentation, and treatment were also reviewed. Discharge disposition was used as surrogate of short-term outcome.

Results

Seventy-two patients were included in the study. The mechanism of injury was gunshot wounds in 71 patients and stab wound in one. Forty-one of the 72 patients (60%) had at least one vascular injury. Twenty-six out of 72 patients suffered an AI (36%), mostly pseudoaneurysms and occlusions, involving the anterior and middle cerebral arteries. Of the 72 patients included, 45 had dedicated computed tomography venograms, and of those 22 had VSI (49%), mainly manifesting as superior sagittal sinus occlusion. In a multivariable regression model, intraventricular hemorrhage at presentation was associated with AI (OR 9.9, p = 0.004). The same was not true for VSI.

Conclusion

Acute traumatic cerebrovascular injury is a prevalent complication in civilian PBI, frequently involving both the arterial and venous sinus systems. Although some radiographic features might be associated with presence of vascular injury, assessment of the intracranial vasculature in the acute phase of all PBI is essential for early diagnosis. Treatment of vascular injury remains variable depending on local practice.

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References

  1. Aarabi B. Management of traumatic aneurysms caused by high velocity missile head wounds. Neurosurg Clin N Am. 1995;6:775–97.

    Article  CAS  Google Scholar 

  2. Aarabi B. Traumatic aneurysms of brain due to high velocity missile head wounds. Neurosurgery. 1988;22:1056–63.

    Article  CAS  Google Scholar 

  3. Aarabi B, Alden T, Chestnut R. Vascular complications of penetrating brain injury. J Trauma. 2001;51(2 Suppl):S26–8.

    Google Scholar 

  4. Amirjamshidi A, Rahmat H, Abbassioun K. Traumatic aneurysms and arteriovenous fistulas of intracranial vessels associated with penetrating head injuries occurring during war: principles and pitfalls in diagnosis and management. A survey of 31 cases and review of the literature. J Neurosurg. 1996;84:769–80.

    Article  CAS  Google Scholar 

  5. Bell RS, Vo AH, Roberts R, Wanebo J, Armonda RA. Wartime traumatic aneurysms: acute presentation, diagnosis, and multimodal treatment of 64 craniocervical arterial injuries. Neurosurgery. 2010;66:66–79.

    Article  Google Scholar 

  6. Haddad FS, Haddad GF, Taha J. Traumatic intracranial aneurysms caused by missiles: their presentation and management. Neurosurgery. 1991;28:1–7.

    Article  CAS  Google Scholar 

  7. Achram M, Rizk G, Haddad FS. Angiographic aspects of traumatic intracranial aneurysms following war injuries. Br J Radiol. 1980;53:1144–9.

    Article  CAS  Google Scholar 

  8. Bank WO, Nelson PB, Drayer BP, Wilkins RH, Rosenbaum AE. Traumatic aneurysm of the basilar artery. AJR Am J Roentgenol. 1978;130:975–7.

    Article  CAS  Google Scholar 

  9. Hachemi M, Jourdan C, Di Roio C, et al. Delayed rupture of traumatic aneurysm after civilian craniocerebral gunshot injury in children. Childs Nerv Syst. 2007;23:283–7.

    Article  CAS  Google Scholar 

  10. Hemphill JC 3rd, Gress DR, Halbach VV. Endovascular therapy of traumatic injuries of the intracranial cerebral arteries. Crit Care Clin. 1999;15:811–29.

    Article  Google Scholar 

  11. Horowitz MB, Kopitnik TA, Landreneau F, et al. Multidisciplinary approach to traumatic intracranial aneurysms secondary to shotgun and handgun wounds. Surg Neurol. 1999;51:31–42.

    Article  CAS  Google Scholar 

  12. Chedid MK, Vender JR, Harrison SJ, McDonnell DE. Delayed appearance of a traumatic intracranial aneurysm. Case report and review of the literature. J Neurosurg. 2001;94:637–41.

    Article  CAS  Google Scholar 

  13. Shallat RF, Taekman MS, Nagle RC. Delayed complications of craniocerebral trauma: case report. Neurosurgery. 1981;8:569–73.

    Article  CAS  Google Scholar 

  14. Benoit BG, Wortzman G. Traumatic cerebral aneurysms: clinical features and natural history. J Neurol Neurosurg Psychiatry. 1973;36:127–38.

    Article  CAS  Google Scholar 

  15. Kieck CF, DeVillers JC. Vascular lesions due to transcranial stab wounds. J Neurosurg. 1984;60:42–6.

    Article  CAS  Google Scholar 

  16. Benzel EC, Day WT, Kesterson L, et al. Civilian craniocerebral gunshot wounds. Neurosurgery. 1991;29:67–72.

    Article  CAS  Google Scholar 

  17. Holmes B, Harbaugh RE. Traumatic intracranial aneurysms: a contemporary review. J Trauma. 1993;35:855–60.

    Article  CAS  Google Scholar 

  18. Larson PS, Reisner A, Morassutti DJ, Abdulhadi B, Harpring JE. Traumatic intracranial aneurysms. Neurosurg Focus. 2000;8:1–6.

    Article  Google Scholar 

  19. Parkinson D, West M. Traumatic intracranial aneurysms. J Neurosurg. 1980;52:11–20.

    Article  CAS  Google Scholar 

  20. Jakobsson KE, Carlsson C, Elfverson J, Von Essen C. Traumatic aneurysms of cerebral arteries. A study of five cases. Acta Neurochir (Wien). 1984;71:91–8.

    Article  CAS  Google Scholar 

  21. Jinkins JR, Dadsetan MR, Sener RN, Desai S, Williams RG. Value of acute-phase angiography in the detection of vascular injuries caused by gunshot wounds to the head: analysis of 12 cases. AJR Am J Roentgenol. 1992;159:365–8.

    Article  CAS  Google Scholar 

  22. Levy ML, Rezai A, Masri LS, et al. The significance of subarachnoid hemorrhage after penetrating craniocerebral injury: correlations with angiography and outcome in a civilian population. Neurosurgery. 1993;32:532–40.

    Article  CAS  Google Scholar 

  23. Bodanapally UK, Saksobhavivat N, Shanmuganathan K, Aarabi B, Roy AK. Arterial injuries after penetrating brain injury in civilians: risk factors on admission head computed tomography. J Neurosurg. 2015;122:219–26.

    Article  Google Scholar 

  24. Bodanapally UK, Krejza J, Saksobhavivat N, et al. Predicting arterial injuries after penetrating brain trauma based on scoring signs from emergency CT studies. Neuroradiol J. 2014;27:138–45.

    Article  Google Scholar 

  25. Bodanapally UK, Shanmuganathan K, Boscak AR, et al. Vascular complications of penetrating brain injury: comparison of helical CT angiography and conventional angiography. J Neurosurg. 2014;121:1275–83.

    Article  Google Scholar 

  26. Loggini A, Vasenina VI, Mansour A, et al. Management of civilians with penetrating brain injury: a systematic review. J Crit Care. 2020;56:159–66.

    Article  Google Scholar 

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Acknowledgments

We wish to acknowledge the support of the Department of Neurology, the Department of Radiology, Section of Neuroradiology, and the Department of Surgery, Sections of Neurosurgery and Trauma at the University of Chicago.

Funding

No sponsorship or funding was available for this study.

Author information

Authors and Affiliations

  1. Neurosciences Intensive Care Unit, Neurocritical Care, Department of Neurology, University of Chicago Medicine and Biological Sciences, 5841 S. Maryland Ave, MC 2030, Chicago, IL, 60637-1470, USA

    Ali Mansour, Andrea Loggini, Faten El Ammar, Christos Lazaridis, Christopher Kramer & Fernando D. Goldenberg

  2. Section of Neuroradiology, Department of Radiology, University of Chicago Medicine and Biological Sciences, Chicago, IL, USA

    Daniel Ginat

  3. Section of Neurosurgery, Department of Surgery, University of Chicago Medicine and Biological Sciences, Chicago, IL, USA

    Ali Mansour, Issam A. Awad, Christos Lazaridis, Christopher Kramer, Valentina Vasenina, Sean P. Polster, Paramita Das, Peleg M. Horowitz & Fernando D. Goldenberg

  4. Pritzker School of Medicine, University of Chicago Medicine and Biological Sciences, Chicago, IL, USA

    Anna Huang & Henry Olivera Perez

  5. Section of Trauma and Acute Care Surgery, Department of Surgery, University of Chicago Medicine and Biological Sciences, Chicago, IL, USA

    Tanya Zakrison, David Hampton & Selwyn O. Rogers

Authors
  1. Ali Mansour
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  2. Andrea Loggini
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  3. Faten El Ammar
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  4. Daniel Ginat
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  5. Issam A. Awad
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  6. Christos Lazaridis
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  7. Christopher Kramer
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  8. Valentina Vasenina
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  9. Sean P. Polster
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  10. Anna Huang
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  11. Henry Olivera Perez
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  12. Paramita Das
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  13. Peleg M. Horowitz
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  14. Tanya Zakrison
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  15. David Hampton
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  16. Selwyn O. Rogers
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  17. Fernando D. Goldenberg
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Contributions

AM was responsible for study concept, study design, data analysis, and drafting the manuscript. AL, FEA, VV, SP, AH, HOP were responsible for data collection, data analysis, and drafting the manuscript. DG was responsible for imaging review. IA, CL, CK, PD, PH, TZ, DH, SO were responsible for critical revision of the manuscript. FG was responsible for critical revision and approval of the final version of the manuscript.

Corresponding author

Correspondence to Ali Mansour.

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Conflicts of interest

None of the authors has any conflicts of interest or financial disclosures to declare.

Ethical approval/Informed consent

This study was approved by the University of Chicago Medical Center (UCMC) Institutional Review Board and ethics standards committee with a waiver of informed consent.

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Mansour, A., Loggini, A., El Ammar, F. et al. Cerebrovascular Complications in Early Survivors of Civilian Penetrating Brain Injury. Neurocrit Care 34, 918–926 (2021). https://doi.org/10.1007/s12028-020-01106-y

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  • DOI: https://doi.org/10.1007/s12028-020-01106-y

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