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European Radiology

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01-02-2016 | Neuro

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

Authors: Karen Buch, Thanh Nguyen, Eric Mahoney, Brandon Libby, Paul Calner, Peter Burke, Alex Norbash, Asim Mian

Published in: European Radiology | Issue 2/2016

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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Title: Association between cervical spine and skull-base fractures and blunt cerebrovascular injury
Authors: Karen Buch
Thanh Nguyen
Eric Mahoney
Brandon Libby
Paul Calner
Peter Burke
Alex Norbash
Asim Mian
Publication date: 01-02-2016
Publisher: Springer Berlin Heidelberg
Published in: European Radiology / Issue 2/2016
Print ISSN: 0938-7994
Electronic ISSN: 1432-1084
DOI: https://doi.org/10.1007/s00330-015-3858-1

At a glance: The STEP trials

Springer Medicine

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

Abstract

Introduction

Materials and methods

Results

Conclusion

Key Points

At a glance: The STEP trials

Springer Medicine

Abstract

Introduction

Materials and methods

Results

Conclusion

Key Points

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