פוסט זה זמין גם ב:
עברית
Sep 30, 2024
Contributor: Travis Barlock MD
Educational Pearls:
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Assessment of head and neck vascular injury due to blunt trauma
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Symptomatic patients require screening head and neck CT angiography
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EAST guidelines include the following criteria for a screening CT angiography in blunt head trauma:
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Unexplained neurological deficits
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Arterial nosebleed
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GCS < 6
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Petrous bone fracture
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Cervical spine fracture
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Any size fracture through the transverse foramen
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LeFort fractures type II or type III
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EAST guidelines include a grading scale for vascular injury:
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Grade I: Luminal irregularity or dissection with <25% luminal narrowing
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Grade II: Dissection or intramural hematoma with >25% luminal narrowing, intraluminal thrombus, or raised intimal flap
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Grade III: Pseudoaneurysm
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Grade IV: Occlusion
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Grade V: Transection with free extravasation
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References
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Bensch FV, Varjonen EA, Pyhältö TT, Koskinen SK. Augmenting Denver criteria yields increased BCVI detection, with screening showing markedly increased risk for subsequent ischemic stroke. Emerg Radiol. 2019;26(4):365-372. doi:10.1007/s10140-019-01677-0
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Biffl WL, Moore EE, Offner PJ, et al. Optimizing screening for blunt cerebrovascular injuries. Am J Surg. 1999;178(6):517-522. doi:10.1016/s0002-9610(99)00245-7
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Kim DY, Biffl W, Bokhari F, et al. Evaluation and management of blunt cerebrovascular injury: A practice management guideline from the Eastern Association for the Surgery of Trauma. J Trauma Acute Care Surg. 2020;88(6):875-887. doi:10.1097/TA.0000000000002668
