Early treatment of blunt cerebrovascular injury with concomitant hemorrhagic neurologic injury is safe and effective.
BACKGROUND
Early pharmacologic treatment for blunt cerebrovascular injury (BCVI) is often withheld when concomitant traumatic brain injury or cervical spinal cord injury occurs. This study examines the safety and efficacy of early treatment for patients with both BCVI and traumatic neurologic injury (TNI).


METHODS
Ten-year retrospective review of patients with BCVI and a TNI was performed. Stroke outcomes for those treated with pharmacologic therapy for their BCVI were compared with those not treated. In addition, the likelihood of worsening of TNI was determined for those exposed to pharmacologic therapy compared with those not exposed. Multivariate logistic regression techniques were used to analyze adjusted odds ratio for stroke risk.


RESULTS
Seventy-seven patients were identified with BCVI + TNI. Strokes occurred in 27% patients with 3 of 21 (14%) strokes present at arrival. There were no differences in baseline characteristics between groups. Stroke rate was higher in the untreated group compared with treated (57% vs. 4%, p < 0.0001). On multivariate regression, treatment status was the most significant stroke predictor (adjusted odds ratio 4.4, 3.0-6.5, p < 0.0001, c-stat 0.93). There was no difference in risk of hemorrhagic deterioration of traumatic brain injury based on pharmacologic exposure versus no exposure (5% vs. 6%, p = 0.6). Likewise, no patient with spinal cord injury worsened as a result of pharmacologic exposure. Of the potentially preventable strokes, 24% (4 of 17) resulted in a stroke-related death and all four deaths occurred in the untreated group.


CONCLUSIONS
The benefit of early treatment for BCVI markedly outweighs the risk of treatment for patients suffering concomitant BCVI and hemorrhagic neurologic injury.


METHODS
: III.
Department of Surgery, Stanford University, 300 Pasteur Drive, Stanford, CA 94305, USA. rcallcut@stanford.edu.
Rachael A
RA
Callcut
Dennis J
DJ
Hanseman
Patrick D
PD
Solan
Kurt S
KS
Kadon
Nichole K
NK
Ingalls
Gerald R
GR
Fortuna
Betty J
BJ
Tsuei
Bryce R H
BR
Robinson
D000293:Adolescent; D000328:Adult; D000368:Aged; D000925:Anticoagulants / Q000627:therapeutic use*; D001930:Brain Injuries / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy* / Q000401:mortality; D002533:Cerebral Angiography; D016009:Chi-Square Distribution; D002648:Child; D005260:Female; D016489:Head Injuries, Closed / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy* / Q000401:mortality; D006801:Humans; D015601:Injury Severity Score; D020300:Intracranial Hemorrhages / Q000175:diagnosis / Q000188:drug therapy* / Q000209:etiology / Q000401:mortality; D016015:Logistic Models; D018810:Magnetic Resonance Angiography; D008297:Male; D008875:Middle Aged; D012042:Registries; D012189:Retrospective Studies; D018570:Risk Assessment; D013124:Spinal Injuries / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy* / Q000401:mortality; D020521:Stroke / Q000209:etiology / Q000401:mortality / Q000517:prevention & control*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
D000925:Anticoagulants