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An Analytical Study of Vascular Trauma in Traumatic Brain Injury

Baskar A.R., Assistant Professor, Department of Neurosurgery, Stanely Medical College, Chennai, Tamil Nadu 600001, India. , Shankar P.1 , Baskar A.R.2

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International Journal of Neurology and Neurosurgery 10(4):p 151-156, Oct-Dec 2018. | DOI: DOI: http://dx.doi.org/10.21088/ijnns.0975.0223.10418.10

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Abstract

  Introduction: “Traumatic brain injury (TBI) still represents the leading cause of morbidity and mortality in individuals under the age of 45 yrs.” There is a large potential spectrum of traumatic vascular injury that may occur in isolation or in different combination. We analyze the various types of blunt cerebrovascular injury in thirty head injury patients. Blunt cerebrovascular injury (BCVI) may be overtly present in more than 1% of patients with blunt trauma.2 Aggressive screening strategies uncover injuries in up to 44% of those screened. If not appropriately diagnosed and treated in a timely manner, many such injuries are responsible for significant morbidity and mortality. Aim of the study: To analyze the various types of blunt cerebrovascular injury in head injury patients. Materials and methods: The patients admitted in the neurosurgical ward with vascular injury involving ICA, Vertebrobasilar artery and its primary branches as identified by CT brain, CT Angiogram, MRI scan, MR Angiogram or DSA either alone or in combination, were included in this study depending on the feasibility of investigation. Results: A total of 3770 head injury patients were admitted in Institute of Neurosurgery during the study period. Based on DENVER’S screening criteria about 95 patients were identified as high risk individuals for blunt cerebro vascular injury. Out of these 95 patients only 30 patients were diagnosed and confirmed to have vascular injury by CT angiogram, DSA and through post mortem. Conculsion: Our conclusions are Patients presenting with Raccoon eye (black eye), anterior skull fracture in sagital direction with CT brain findings suggestive of ischemia in the MCA/ACA territory were more likely to have supra clinoid ICA injury, Patients with Battle’s sign, petrous bone fracture in transverse axis and CT brain showing features of ischemia were more likely to have ICA injury, Patients with Battle’s sign, occipital bone fracture extending into the petrous part of temporal bone were more likely to have bilateral ICA or Vertebra basilar artery injury.

Keywords: Traumatic Brain Injury; Blunt Cerebrovascular Injury; Head Injury.

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DOI: DOI: http://dx.doi.org/10.21088/ijnns.0975.0223.10418.10

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