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Spine
Diagnosis
Trauma
Cord, Dura, and Vessels
Vascular Injury, Cervical
Vascular Injury, Cervical
Jeffrey S. Ross, MD
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KEY FACTS

  • Terminology

    • Imaging

      • Pathology

        • Clinical Issues

          TERMINOLOGY

          • Synonyms

            • Blunt cerebrovascular injury (BCVI)
            • Carotid artery injury (CAI)
            • Vertebral artery injury (VAI)

          • Definitions

            • Traumatic injury to either carotid or vertebral arteries
              • Dissection
              • Thrombosis
              • Pseudoaneurysm
              • Transection

          IMAGING

          • General Features

            • CT Findings

              • MR Findings

                • Ultrasonographic Findings

                  • Imaging Recommendations

                    • Angiographic Findings

                      DIFFERENTIAL DIAGNOSIS

                        PATHOLOGY

                        • General Features

                          • Staging, Grading, & Classification

                            • Gross Pathologic & Surgical Features

                              CLINICAL ISSUES

                              • Presentation

                                • Demographics

                                  • Natural History & Prognosis

                                    • Treatment

                                      DIAGNOSTIC CHECKLIST

                                      • Consider

                                        • Image Interpretation Pearls

                                          Selected References

                                          1. Galardi MM et al: Cerebrovascular complications of pediatric blunt trauma. Pediatr Neurol. S0887-8994(19)30999-3, 2020
                                          2. Rutman AM et al: Imaging and management of blunt cerebrovascular injury. Radiographics. 38(2):542-63, 2018
                                          3. Stone DK et al: Management of blunt cerebrovascular injury. Curr Neurol Neurosci Rep. 18(12):98, 2018
                                          4. Winn A et al: Blunt craniocervical trauma: does the patient have a cerebral vascular injury? Neuroimaging Clin N Am. 28(3):495-507, 2018
                                          5. Harrigan MR et al: Management of vertebral artery injuries following non-penetrating cervical trauma. Neurosurgery. 72 Suppl 2:234-43, 2013
                                          6. Munera F et al: Multi-detector row CT angiography of the neck in blunt trauma. Radiol Clin North Am. 50(1):59-72, 2012
                                          7. Albuquerque FC et al: Craniocervical arterial dissections as sequelae of chiropractic manipulation: patterns of injury and management. J Neurosurg. 115(6):1197-205, 2011
                                          8. Fusco MR et al: Cerebrovascular dissections--a review part I: spontaneous dissections. Neurosurgery. 68(1):242-57; discussion 257, 2011
                                          9. Fusco MR et al: Cerebrovascular dissections: a review. Part II: blunt cerebrovascular injury. Neurosurgery. 68(2):517-30; discussion 530, 2011
                                          10. Ringer AJ et al: Screening for blunt cerebrovascular injury: selection criteria for use of angiography. J Neurosurg. 112(5):1146-9, 2010
                                          11. Lee CK et al: Traumatic vertebral artery injury: detailed clinicopathologic and morphometric analysis of 6 cases. Am J Forensic Med Pathol. 30(2):134-6, 2009
                                          12. Yeh HF et al: Traumatic vertebral artery dissection and Wallenberg syndrome after a motorcycle collision. Am J Emerg Med. 27(1):131, 2009
                                          13. Hoit DA et al: Angiographic detection of carotid and vertebral arterial injury in the high-energy blunt trauma patient. J Spinal Disord Tech. 21(4):259-66, 2008
                                          14. Stallmeyer MJ et al: Imaging of traumatic neurovascular injury. Radiol Clin North Am. 44(1):13-39, vii, 2006
                                          15. Torina PJ et al: Incidence of vertebral artery thrombosis in cervical spine trauma: correlation with severity of spinal cord injury. AJNR Am J Neuroradiol. 26(10):2645-51, 2005
                                          16. Pride GL Jr et al: Stent-coil treatment of a distal internal carotid artery dissecting pseudoaneurysm on a redundant loop by use of a flexible, dedicated nitinol intracranial stent. AJNR Am J Neuroradiol. 25(2):333-7, 2004
                                          17. du Toit DF et al: Neurologic outcome after penetrating extracranial arterial trauma. J Vasc Surg. 38(2):257-62, 2003
                                          18. Miller PR et al: Prospective screening for blunt cerebrovascular injuries: analysis of diagnostic modalities and outcomes. Ann Surg. 236(3):386-93; discussion 393-5, 2002
                                          19. Miller PR et al: Blunt cerebrovascular injuries: diagnosis and treatment. J Trauma. 51(2):279-85; discussion 285-6, 2001
                                          20. Stevinson C et al: Neurological complications of cervical spine manipulation. J R Soc Med. 94(3):107-10, 2001
                                          21. Touzé E et al: Aneurysmal forms of cervical artery dissection : associated factors and outcome. Stroke. 32(2):418-23, 2001
                                          22. Biffl WL et al: The devastating potential of blunt vertebral arterial injuries. Ann Surg. 231(5):672-81, 2000
                                          23. Biffl WL et al: Optimizing screening for blunt cerebrovascular injuries. Am J Surg. 178(6):517-22, 1999
                                          24. Carrillo EH et al: Blunt carotid artery injuries: difficulties with the diagnosis prior to neurologic event. J Trauma. 46(6):1120-5, 1999
                                          25. Guillon B et al: Long-term follow-up of aneurysms developed during extracranial internal carotid artery dissection. Neurology. 53(1):117-22, 1999
                                          26. Alimi Y et al: Bilateral dissection of the internal carotid artery at the base of the skull due to blunt trauma: incidence and severity. Ann Vasc Surg. 12(6):557-65, 1998
                                          27. Sclafani AP et al: Angiography and transcatheter arterial embolization of vascular injuries of the face and neck. Laryngoscope. 106(2 Pt 1):168-73, 1996
                                          28. Cogbill TH et al: The spectrum of blunt injury to the carotid artery: a multicenter perspective. J Trauma. 37(3):473-9, 1994
                                          29. Martin RF et al: Blunt trauma to the carotid arteries. J Vasc Surg. 14(6):789-93; discussion 793-5, 1991
                                          30. Krajewski LP et al: Blunt carotid artery trauma: report of two cases and review of the literature. Ann Surg. 191(3):341-6, 1980
                                          Related Anatomy
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                                          Related Differential Diagnoses
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                                          References
                                          Tables

                                          Tables

                                          KEY FACTS

                                          • Terminology

                                            • Imaging

                                              • Pathology

                                                • Clinical Issues

                                                  TERMINOLOGY

                                                  • Synonyms

                                                    • Blunt cerebrovascular injury (BCVI)
                                                    • Carotid artery injury (CAI)
                                                    • Vertebral artery injury (VAI)

                                                  • Definitions

                                                    • Traumatic injury to either carotid or vertebral arteries
                                                      • Dissection
                                                      • Thrombosis
                                                      • Pseudoaneurysm
                                                      • Transection

                                                  IMAGING

                                                  • General Features

                                                    • CT Findings

                                                      • MR Findings

                                                        • Ultrasonographic Findings

                                                          • Imaging Recommendations

                                                            • Angiographic Findings

                                                              DIFFERENTIAL DIAGNOSIS

                                                                PATHOLOGY

                                                                • General Features

                                                                  • Staging, Grading, & Classification

                                                                    • Gross Pathologic & Surgical Features

                                                                      CLINICAL ISSUES

                                                                      • Presentation

                                                                        • Demographics

                                                                          • Natural History & Prognosis

                                                                            • Treatment

                                                                              DIAGNOSTIC CHECKLIST

                                                                              • Consider

                                                                                • Image Interpretation Pearls

                                                                                  Selected References

                                                                                  1. Galardi MM et al: Cerebrovascular complications of pediatric blunt trauma. Pediatr Neurol. S0887-8994(19)30999-3, 2020
                                                                                  2. Rutman AM et al: Imaging and management of blunt cerebrovascular injury. Radiographics. 38(2):542-63, 2018
                                                                                  3. Stone DK et al: Management of blunt cerebrovascular injury. Curr Neurol Neurosci Rep. 18(12):98, 2018
                                                                                  4. Winn A et al: Blunt craniocervical trauma: does the patient have a cerebral vascular injury? Neuroimaging Clin N Am. 28(3):495-507, 2018
                                                                                  5. Harrigan MR et al: Management of vertebral artery injuries following non-penetrating cervical trauma. Neurosurgery. 72 Suppl 2:234-43, 2013
                                                                                  6. Munera F et al: Multi-detector row CT angiography of the neck in blunt trauma. Radiol Clin North Am. 50(1):59-72, 2012
                                                                                  7. Albuquerque FC et al: Craniocervical arterial dissections as sequelae of chiropractic manipulation: patterns of injury and management. J Neurosurg. 115(6):1197-205, 2011
                                                                                  8. Fusco MR et al: Cerebrovascular dissections--a review part I: spontaneous dissections. Neurosurgery. 68(1):242-57; discussion 257, 2011
                                                                                  9. Fusco MR et al: Cerebrovascular dissections: a review. Part II: blunt cerebrovascular injury. Neurosurgery. 68(2):517-30; discussion 530, 2011
                                                                                  10. Ringer AJ et al: Screening for blunt cerebrovascular injury: selection criteria for use of angiography. J Neurosurg. 112(5):1146-9, 2010
                                                                                  11. Lee CK et al: Traumatic vertebral artery injury: detailed clinicopathologic and morphometric analysis of 6 cases. Am J Forensic Med Pathol. 30(2):134-6, 2009
                                                                                  12. Yeh HF et al: Traumatic vertebral artery dissection and Wallenberg syndrome after a motorcycle collision. Am J Emerg Med. 27(1):131, 2009
                                                                                  13. Hoit DA et al: Angiographic detection of carotid and vertebral arterial injury in the high-energy blunt trauma patient. J Spinal Disord Tech. 21(4):259-66, 2008
                                                                                  14. Stallmeyer MJ et al: Imaging of traumatic neurovascular injury. Radiol Clin North Am. 44(1):13-39, vii, 2006
                                                                                  15. Torina PJ et al: Incidence of vertebral artery thrombosis in cervical spine trauma: correlation with severity of spinal cord injury. AJNR Am J Neuroradiol. 26(10):2645-51, 2005
                                                                                  16. Pride GL Jr et al: Stent-coil treatment of a distal internal carotid artery dissecting pseudoaneurysm on a redundant loop by use of a flexible, dedicated nitinol intracranial stent. AJNR Am J Neuroradiol. 25(2):333-7, 2004
                                                                                  17. du Toit DF et al: Neurologic outcome after penetrating extracranial arterial trauma. J Vasc Surg. 38(2):257-62, 2003
                                                                                  18. Miller PR et al: Prospective screening for blunt cerebrovascular injuries: analysis of diagnostic modalities and outcomes. Ann Surg. 236(3):386-93; discussion 393-5, 2002
                                                                                  19. Miller PR et al: Blunt cerebrovascular injuries: diagnosis and treatment. J Trauma. 51(2):279-85; discussion 285-6, 2001
                                                                                  20. Stevinson C et al: Neurological complications of cervical spine manipulation. J R Soc Med. 94(3):107-10, 2001
                                                                                  21. Touzé E et al: Aneurysmal forms of cervical artery dissection : associated factors and outcome. Stroke. 32(2):418-23, 2001
                                                                                  22. Biffl WL et al: The devastating potential of blunt vertebral arterial injuries. Ann Surg. 231(5):672-81, 2000
                                                                                  23. Biffl WL et al: Optimizing screening for blunt cerebrovascular injuries. Am J Surg. 178(6):517-22, 1999
                                                                                  24. Carrillo EH et al: Blunt carotid artery injuries: difficulties with the diagnosis prior to neurologic event. J Trauma. 46(6):1120-5, 1999
                                                                                  25. Guillon B et al: Long-term follow-up of aneurysms developed during extracranial internal carotid artery dissection. Neurology. 53(1):117-22, 1999
                                                                                  26. Alimi Y et al: Bilateral dissection of the internal carotid artery at the base of the skull due to blunt trauma: incidence and severity. Ann Vasc Surg. 12(6):557-65, 1998
                                                                                  27. Sclafani AP et al: Angiography and transcatheter arterial embolization of vascular injuries of the face and neck. Laryngoscope. 106(2 Pt 1):168-73, 1996
                                                                                  28. Cogbill TH et al: The spectrum of blunt injury to the carotid artery: a multicenter perspective. J Trauma. 37(3):473-9, 1994
                                                                                  29. Martin RF et al: Blunt trauma to the carotid arteries. J Vasc Surg. 14(6):789-93; discussion 793-5, 1991
                                                                                  30. Krajewski LP et al: Blunt carotid artery trauma: report of two cases and review of the literature. Ann Surg. 191(3):341-6, 1980