Association between cervical spine and skull-base fractures and blunt cerebrovascular injury

Abstract

Introduction

Blunt cerebrovascular injuries (BCVI) are associated with high morbidity and mortality and can lead to neurological deficits. The established criteria for patients undergoing CT angiography (CTA) for BCVI are broad, and can expose patients to radiation unnecessarily. This study aimed to examine the prevalence of BCVI in patients on CTA and determine presentations associated with the highest rates of BCVI.

Materials and methods

With IRB approval, patients were selected for CTA screening for BCVI according to a predefined set of criteria at our hospital between 2007 and 2010. Patients were identified from our institution’s trauma database. CTAs were retrospectively reviewed for BCVI including vasospasm and dissection. Electronic medical records were reviewed for clinical presentation and hospital course.

Results

Of 432 patients, vasospasm (n = 10) and/or dissection (n = 36) were found in 46 patients (10.6 %). BCVI was associated with cervical spine and/or skull-base fracture in 40/46 patients (87 %, P < 0.0001). Significant correlations were seen between dissection and fracture in 31/36 patients (86.2 %, p < 0.0001) and between BCVI and both neurological deficits and fractures (27/44, P < 0.0001).

Conclusion

BCVI was significantly associated with cervical and/or skullbase fractures and neurological deficits with coexistent fractures. Patients with these injuries should be prioritized for rapid CTA evaluation for BCVI.

Key Points

CTA screening is important to identify patients with underlying BCVI

Cervical spine and/or skullbase fractures were significantly associated with BCVI

BCVI may occur in up to 11 % of patients with blunt trauma injuries

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Abbreviations

BCVI:

Blunt cerebrovascular injury

CTA:

Computed tomography angiography

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Acknowledgments

This study was an oral presentation at the 2013 ASNR Annual Meeting. The scientific guarantor of this publication is Dr. Asim Mian at the Boston University Medical Center. The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article. The authors state that this work has not received any funding. No statistician was included in this study as no complex statistical methods were necessary for this paper. This study was approved by the Institutional Review Board at Boston University Medical Center. Written informed consent was waived by the Institutional Review Board. No results on the study subjects or cohorts have been previously published, but the findings in this study were presented at the 2013 American Society of Neuroradiology Annual Meeting. This study was performed as a retrospective, cross-sectional study performed at one institution.

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Buch, K., Nguyen, T., Mahoney, E. et al. Association between cervical spine and skull-base fractures and blunt cerebrovascular injury. Eur Radiol 26, 524–531 (2016). https://doi.org/10.1007/s00330-015-3858-1

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Keywords

  • Blunt trauma
  • Computed tomography angiogram
  • Vascular system injuries
  • Dissection
  • Cerebrovascular trauma