Cerebral embolism following blunt extracranial vascular trauma: a report of two cases

Transient cortical blindness following a Hangman's fracture: a case report and review of literature

We describe a case with transient cortical blindness after trauma with no obvious structural damage to the vertebral artery in the presence of a C2 spondylolisthesis. A patient complaining of blindness in a setting of polytrauma should always alert the possibility of a cervical spine injury with vertebral artery ischaemia.

Does improved detection of blunt vertebral artery injuries lead to improved outcomes? Analysis of the National Trauma Data Bank

BACKGROUND

The rate of blunt vertebral artery (BVI) has increased in institutions using aggressive screening protocols. It is unclear whether earlier diagnosis and therapy have improved outcomes. Our goal was to estimate the national incidence of BVI and BVI-related stroke (BVI-S), and report on the functional outcome of patients with this diagnosis.

METHODS

The annual rates of BVI and BVI-S were estimated by using the National Trauma Data Bank (NTDB) from 2001 to 2005. The functional outcome was evaluated by the modified functional independence measure (FIM) score (range, 3-12).

RESULTS

A total of 574 patients with BVI were identified among the 761,385 blunt trauma admissions (0.075% overall incidence). BVI-S was diagnosed in 12% of patients with BVI and no associated blunt carotid injury. The FIM on discharge was 9.62 +/- 2.78 (range, 3-12), and 49% of the patients showed complete functional independence. Overall mortality was 8%. The annual incidence showed a steady increase from 0.053% in 2001 to 0.1% in 2005 (p < 0.001). No difference in annual BVI-S and complete functional independence was observed.

CONCLUSIONS

As a result of increased awareness, the nation-wide rate of detection of BVI has doubled in recent years. However, BVI-S rates and functional outcome have not improved, raising questions about the available treatment protocols.

Vertebral artery trauma

Vertebral artery trauma is not commonly seen by forensic pathologists. The experience of vertebral artery trauma at the Victorian Institute of Forensic Medicine (30 cases) is summarized and reviewed in the light of the literature. Causes of vertebral artery trauma are discussed. In case 1, the history and timing of the injury raise the question as to whether the vertebral artery dissection occurred before the episode of trauma, that is, was spontaneous or resulted from trauma. Moreover, underlying vertebral artery disease was present, raising the question as to how much trauma was needed to cause vertebral artery dissection. In case 2, despite the history of head/neck trauma, a neurosurgeon considered the subarachnoid hemorrhage was spontaneous, due most likely to ruptured saccular aneurysm or arteriovenous malformation. In case 3, the vertebral artery rupture was not diagnosed in the setting of multiple injuries. Case 4 is an example of prolonged survival with delayed onset of symptoms following vertebral artery trauma. Case 5 is an example of the not uncommon scenario of homicidal vertebral artery trauma accounting for basal subarachnoid hemorrhage, rapid collapse and death. Cases 1 and 4 indicate that relatively normal activity may be possible following vertebral artery trauma in some cases (at least for a time). Cases 1 and 4 are also examples of intracranial vertebral artery dissection.

Non-penetrating trauma to the carotid artery with secondary thrombosis and embolism: treatment by thrombolysin

A case of partially occluding post-traumatic thrombosis of the internal carotid artery and secondary embolism of the middle cerebral artery is reported. The patient was treated with Thrombolysin with coincident resolution of clinical symptoms and signs and clearing of the lesions on arteriography. This may have been fortuitous. The subject of traumatic carotid artery thrombosis is reviewed in detail, and its pathophysiology is discussed, especially in relation to facts known about occlusive vascular disease secondary to atherosclerosis and related embolic phenomena. Suggestions are made concerning the treatment of this condition, especially with regard to developing rational criteria for opening vascular beds through evaluation of collateral cerebral blood flow. The uses of microvascular surgical techniques and thrombolytic therapy are considered.