Paucis Verbis: Blunt cerebrovascular injuries

In the setting of blunt trauma, it is easily to overlook a patient's risk for blunt cerebrovascular injuries (BCVI). These are injuries to the carotid and vertebral arteries. Often they are asymptomatic with the initial injury, but the goal is to detect them before they develop a delayed stroke.

• Who are at risk for these injuries? 
• What kind of imaging should I order to rule these injuries out? 
• Do I really treat these patients with antithrombotic agents even in the setting of trauma to reduce the incidence of CVA?

FYI: A simple seat-belt sign along the neck does not warrant a CT angiogram. Patients with higher risk findings such as significant pain, tenderness, swelling, and/or a bruit probably need imaging.

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Reference
Burlew CC, Biffl WL. Imaging for blunt carotid and vertebral artery injuries. Surgical Clinics of North America. 2011, 91(1), 217-31. PMID: 21184911
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