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Blunt cerebrovascular injuries in acute trauma care: a screening protocol

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Abstract

Introduction

Blunt cerebrovascular injuries (BCVI) of the extra- or intracerebral vessels are frequently observed lesions which may lead to thrombembolic events with focal neurological deficits, stroke or death particularly in patients <60 years. However, a comprehensive standardised clinical algorithm for screening and management of these secondary injuries is still lacking.

Materials and methods

We developed a standardised screening protocol applicable for mild as well as severely injured patients. In this prospective cohort study, we evaluated the feasibility of this diagnostic algorithm in a level 1 trauma centre setting. Trauma patients who met the inclusion criteria underwent a computed tomographic angiography (CTA) as part of standard diagnostic procedure at admission. All suspicions or positive findings were reevaluated by a conventional four-vessel catheter angiography within the first 72 h after trauma. Within this period, anticoagulation with low-dose heparin was started. BCVI confirmation indicated a shift to systemic heparinisation with overlapping phenprocoumon therapy for at least 6 months. All patients were reevaluated after 6 months by another four-vessel angiography. Depending on the diagnostic findings, oral anticoagulation may be discontinued or continued for another 6 months.

Results

A total of 44 patients (8 male, 6 female, age range 19–95 years) were included in the study. 20 BCVIs were detected in 16 patients (36.3%). The most common injuries identified were Biffl Type II (40%) and Type IV lesions (30%). 86.4% of the patients received a CTA upon admission, 93.2% of which were conducted within 12 h posttrauma. None of the patients had a secondary thrombembolic neurological event during the hospital stay or within 3 months postdischarge.

Conclusion

Our results indicate that implementation of the screening protocol can prevent strokes in patients without primary thrombembolic neurological deficits.

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Authors and Affiliations

  1. Department of Trauma-, Hand- and Reconstructive Surgery, University Hospital Münster, Waldeyerstr. 1, 48161, Münster, Germany

    L. Löhrer, R. Hartensuer, M. J. Raschke & T. Vordemvenne

  2. Department of Clinical Radiology, University Hospital Münster, Münster, Germany

    V. Vieth, I. Nassenstein & T. Niederstadt

Authors
  1. L. Löhrer
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  2. V. Vieth
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  3. I. Nassenstein
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  4. R. Hartensuer
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  5. T. Niederstadt
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  6. M. J. Raschke
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  7. T. Vordemvenne
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Correspondence to T. Vordemvenne.

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Löhrer, L., Vieth, V., Nassenstein, I. et al. Blunt cerebrovascular injuries in acute trauma care: a screening protocol. Eur Spine J 21, 837–843 (2012). https://doi.org/10.1007/s00586-011-2009-x

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  • DOI: https://doi.org/10.1007/s00586-011-2009-x

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