Clinical characteristics and mechanisms of stroke after polytrauma.
OBJECTIVE
To describe the clinical characteristics of acute stroke attributable to trauma and to analyze the mechanisms and effect of stroke on outcome in patients with polytrauma.


METHODS
We retrospectively reviewed the medical records of patients with polytrauma complicated by stroke at the Mayo Clinic in Rochester, Minn. The diagnosis of stroke was matched with trauma for the period between January 1, 1985, and December 31, 2001. Polytrauma was defined as at least 2 injuries that involve at least 1 vital organ (eg, lung or liver) and necessitate patient admission to a trauma intensive care unit.


RESULTS
We identified 14 patients with polytrauma who had experienced a stroke (13 ischemic and 1 hemorrhagic). Craniocervical artery dissection was the most common mechanism (7 patients), and skull or facial fractures were a possible marker for this (5 of 7 patients). There were frequent delays in identifying stroke, with limb fracture on the side of the paresis (5 of 6 patients) being a possible factor. Four patients died of postischemic brain swelling, and 5 had major neurologic impairment.


CONCLUSIONS
Stroke after polytrauma is due to various mechanisms, is frequently difficult to recognize early, and profoundly affects patient outcome.
Blacker
David J
DJ
Department of Neurology, Mayo Clinic College of Medicine, Rochester, Minn 55905, USA.
Wijdicks
Eelco F M
EF
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D015600:Glasgow Coma Scale; D006801:Humans; D008297:Male; D008875:Middle Aged; D009104:Multiple Trauma / Q000150:complications* / Q000503:physiopathology / Q000628:therapy; D020127:Recovery of Function; D012189:Retrospective Studies; D020521:Stroke / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology; D013997:Time Factors; D016896:Treatment Outcome