title: Patients with Blunt Traumatic Brain Injury: A Role for Computed Tomography Angiography of the Head to Evaluate Nontraumatic Causes?
abstract: BACKGROUND
  In the setting of trauma, the cause of intracranial hemorrhage (ICH) is frequently attributed to the physical, traumatic event. Caution should still be directed toward nontraumatic (or spontaneous) causes responsible for the trauma, such as hypertension, cerebral amyloid angiopathy, aneurysms, vascular malformation, and hemorrhagic infarcts. The role for immediate computed tomography angiography remains controversial to evaluate for nontraumatic causes.
  
  
  METHODS
  A systematic review of the available literature in the Medline PubMed database.
  
  
  RESULTS
  In the available literature, only 12 patients with traumatic brain injury underwent computed tomography angiography of the head that either showed a vascular malformation and/or altered clinical management because of concerns of a vascular malformation. The ICH in 11 patients was attributed to rupture of a cerebral aneurysm; the other patient received a diagnostic angiogram that was negative.
  
  
  CONCLUSIONS
  ICH in patients with traumatic brain injury seems to be vastly associated with the traumatic event. Only rare cases have been attributed to aneurysmal rupture. None has been associated with arteriovenous malformation. Nevertheless, clinical vigilance remains reasonable, especially in younger patients and those with hemorrhage within the subarachnoid cisterns or sylvian fissure.
authors.affiliation: Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA. Electronic address: hsnguyen@mcw.edu.
authors.forename: Ha Son
authors.initials: HS
authors.lastname: Nguyen
authors.affiliation: Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA.
authors.forename: Ninh
authors.initials: N
authors.lastname: Doan
authors.affiliation: Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA.
authors.forename: Michael
authors.initials: M
authors.lastname: Gelsomino
authors.affiliation: Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA.
authors.forename: Saman
authors.initials: S
authors.lastname: Shabani
mesh_terms: D000070642:Brain Injuries, Traumatic / Q000000981:diagnostic imaging* / Q000453:epidemiology; D000072226:Computed Tomography Angiography / Q000379:methods* / Q000592:standards*; D015600:Glasgow Coma Scale / Q000592:standards*; D006257:Head / Q000000981:diagnostic imaging*; D006801:Humans
keywords: CT angiography; CTA; TBI; Traumatic brain injury