Vascular injuries - Neck


High risk for Blunt Cerebro-Vascular Injuries (BCVI)

  • Any neurologic abnormality that is unexplained by a diagnosed injury
  • Blunt trauma patients presenting with epistaxis from a suspected arterial source after trauma

Asymptomatic patients at risk include those with:

  • Petrous bone fracture
  • Diffuse axonal injury
  • Cervical fracture - particularly C1-C3 - or with narrowing of the foramen transversarium
  • Cervical spine fracture with subluxation or rotation
  • Le Fort II or III facial fractures

Paediatric trauma patients should be evaluated using the same criteria as the adult population.

Imaging/Screening (Biffl) criteria

Injury mechanism

  • Severe hyperextension/rotation or hyperflexion particularly with facial fractures or head injury with diffuse axonal injury
  • Hanging with anoxic brain injury

Physican signs

  • Belt abrasion / contusion of anterior neck with significant swelling or altered mental status

Fractures close to carotid or vertebral arteries.

  • Base of skull involving carotid canal
  • Cervical vertebral body fractures with narrowing of the foramen transversarium


  • 4 vessel cerebral angiography is the "gold standard"
  • CTA may be considered as screening prior to angiography


  • Grade 1 and 2 injuries = use antithrombotics - Aspirin or Heparin. If heparin, use without bolus
  • Grade 3 injuries (pseudoaneurysm): require vasc/neurosurgery/interventional radiology
  • Neuro deficit and accessible carotid lesion: radiology/neurosurgery/vascular surgery

Content by Dr Íomhar O' Sullivan 07/02/2017. Last review Dr ÍOS 21/06/21.