title: Long-term follow-up of blunt cerebrovascular injuries: Does time heal all wounds?
abstract: The short-term natural history of blunt cerebrovascular injuries (BCVIs) has been previously described in the literature, but the purpose of this study was to analyze long-term serial follow-up and lesion progression of BCVI.
  
  
  
  This is a single institution's retrospective review of a prospectively collected database over four years (2009-2013). All patients with a diagnosis of BCVI by computed tomographic (CT) scan were identified, and injuries were graded based on modified Denver scale. Management followed institutional algorithm: initial whole-body contrast-enhanced CT scan, followed by CT angiography at 24 to 72 hours, 5 to 7 days, 4 to 6 weeks, and 3 months after injury. All follow-up imaging, medication management, and clinical outcomes through 6 months following injury were recorded.
  
  
  
  There were 379 patients with 509 injuries identified. Three hundred eighty-one injuries were diagnosed as BCVI on first CT (Grade 1 injuries, 126; Grade 2 injuries, 116; Grade 3 injuries, 69; and Grade 4 injuries, 70); 100 "indeterminate" on whole-body CT; 28 injuries were found in patients reimaged only for lesions detected in other vessels. Sixty percent were male, mean (SD) age was 46.5 (19.9) years, 65% were white, and 62% were victims of a motor vehicle crash. Most frequently, Grade 1 injuries were resolved at all subsequent time points. Up to 30% of Grade 2 injuries worsened, but nearly 50% improved or resolved. Forty-six percent of injuries originally not detected were subsequently diagnosed as Grade 3 injuries. Greater than 70% of all imaged Grade 3 and Grade 4 injuries remained unchanged at all subsequent time points.
  
  
  
  This study revealed that there are many changes in grade throughout the six-month time period, especially the lesions that start out undetectable or indeterminate, which become various grade injuries. Low-grade injuries (Grades 1 and 2) are likely to remain stable and eventually resolve. Higher-grade injuries (Grades 3 and 4) persist, many up to six months. Inpatient treatment with antiplatelet or anticoagulation did not affect BCVI progression.
  
  
  
  Prognostic study, level III; therapeutic study, level IV.
authors.affiliation: From the R Adams Cowley Shock Trauma Center, Department of Surgery (A.L., B.R.B., R.B.T., M.H.L., T.M.S., D.M.S.), University of Maryland Medical Center, R Adams Cowley Shock Trauma Center, Department of Radiology and Nuclear Medicine (C.W.S.), University of Maryland Medical Center, National Study Center for Trauma and EMS (J.K.), University of Maryland School of Medicine, and University of Maryland School of Medicine (A.K.), Baltimore, Maryland; and Department of Surgery (T.F.), Tufts Medical Center, Boston, Massachusetts.
authors.forename: Adriana
authors.initials: A
authors.lastname: Laser
authors.forename: Brandon R
authors.initials: BR
authors.lastname: Bruns
authors.forename: Joseph A
authors.initials: JA
authors.lastname: Kufera
authors.forename: Andrew I
authors.initials: AI
authors.lastname: Kim
authors.forename: Timothy
authors.initials: T
authors.lastname: Feeney
authors.forename: Ronald B
authors.initials: RB
authors.lastname: Tesoriero
authors.forename: Margaret H
authors.initials: MH
authors.lastname: Lauerman
authors.forename: Clint W
authors.initials: CW
authors.lastname: Sliker
authors.forename: Thomas M
authors.initials: TM
authors.lastname: Scalea
authors.forename: Deborah M
authors.initials: DM
authors.lastname: Stein
mesh_terms: D000328:Adult; D000368:Aged; D020214:Cerebrovascular Trauma / Q000473:pathology* / Q000503:physiopathology* / Q000628:therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D014945:Wound Healing; D014949:Wounds, Nonpenetrating / Q000473:pathology* / Q000503:physiopathology* / Q000628:therapy