Abstract
Purpose of Review
This review provides an updated summary of blunt cerebrovascular injury (BCVI) to guide clinicians in its early diagnosis and prevention and treatment of stroke associated with such injury.
Recent Findings
Untreated BCVI causes stroke in 10–40% of patients, but more than half will not present with stroke symptoms initially. Risk of stroke is highest in the first 7 days, with a peak in the first 24 h. Computed tomography (CT) angiography is currently the screening modality of choice, although digital subtraction angiography may still be required in some cases. Antithrombotic therapy is the mainstay of treatment and has proven safety in trauma patients. In carefully selected patients, endovascular intervention may also be beneficial.
Summary
BCVI is a potentially preventable cause of stroke. A high index of suspicion is needed as emergent screening during initial evaluation can provide a window for stroke prevention. Screening all patients with injuries that would otherwise prompt CT scans of the neck or chest is recommended. Treatment is guided by grade of injury. Early treatment with antithrombotics has been shown to be both effective and safe.
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The authors would like to thank Dr. Howard S. Kirshner for the topic title and initial topic review.
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Christina A. Wilson reports personal fees from UpToDate, personal fees from Medlink Neurology, outside the submitted work. David K. Stone and Vyas T. Viswanathan each declare no potential conflicts of interest.
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Stone, D.K., Viswanathan, V.T. & Wilson, C.A. Management of Blunt Cerebrovascular Injury. Curr Neurol Neurosci Rep 18, 98 (2018). https://doi.org/10.1007/s11910-018-0906-7
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DOI: https://doi.org/10.1007/s11910-018-0906-7