title: Association between cervical spine and skull-base fractures and blunt cerebrovascular injury.
abstract: BACKGROUND
  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.
  
  
  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).
  
  
  CONCLUSIONS
  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.
  
  
  CONCLUSIONS
  • 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.
authors.affiliation: Department of Radiology, Boston Medical Center, Boston University School of Medicine, 820 Harrison Avenue, FGH Building 3rd Floor, Boston, MA, 02118, USA. karen.buch@bmc.org.
authors.forename: Karen
authors.initials: K
authors.lastname: Buch
authors.affiliation: Department of Radiology, Boston Medical Center, Boston University School of Medicine, 820 Harrison Avenue, FGH Building 3rd Floor, Boston, MA, 02118, USA.
authors.forename: Thanh
authors.initials: T
authors.lastname: Nguyen
authors.affiliation: Department of Surgery, Boston Medical Center, Boston University School of Medicine, Boston, MA, USA.
authors.forename: Eric
authors.initials: E
authors.lastname: Mahoney
authors.affiliation: Department of Emergency Medicine, Boston Medical Center, Boston University School of Medicine, Boston, MA, USA.
authors.forename: Brandon
authors.initials: B
authors.lastname: Libby
authors.affiliation: Department of Emergency Medicine, Boston Medical Center, Boston University School of Medicine, Boston, MA, USA.
authors.forename: Paul
authors.initials: P
authors.lastname: Calner
authors.affiliation: Department of Surgery, Boston Medical Center, Boston University School of Medicine, Boston, MA, USA.
authors.forename: Peter
authors.initials: P
authors.lastname: Burke
authors.affiliation: Department of Radiology, Boston Medical Center, Boston University School of Medicine, 820 Harrison Avenue, FGH Building 3rd Floor, Boston, MA, 02118, USA.
authors.forename: Alex
authors.initials: A
authors.lastname: Norbash
authors.affiliation: Department of Radiology, Boston Medical Center, Boston University School of Medicine, 820 Harrison Avenue, FGH Building 3rd Floor, Boston, MA, 02118, USA. asim.mian@bmc.org.
authors.forename: Asim
authors.initials: A
authors.lastname: Mian
mesh_terms: D020214:Cerebrovascular Trauma / Q000150:complications* / Q000000981:diagnostic imaging*; D002574:Cervical Vertebrae / Q000000981:diagnostic imaging; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012886:Skull / Q000000981:diagnostic imaging; D012887:Skull Fractures / Q000150:complications* / Q000000981:diagnostic imaging; D016103:Spinal Fractures / Q000150:complications* / Q000000981:diagnostic imaging; D014057:Tomography, X-Ray Computed; D014949:Wounds, Nonpenetrating / Q000150:complications* / Q000000981:diagnostic imaging
keywords: Blunt trauma; Cerebrovascular trauma; Computed tomography angiogram; Dissection; Vascular system injuries