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