Blunt Cerebrovascular Injury (BCVI)

VBMC TRAUMA CARE SERVICES GUIDELINE

Blunt Cerebrovascular Injury Screening and Treatment Guideline

Blunt cerebrovascular injuries (BCVI) were once thought to be rare events but can occur in up to 30% of patients with some injury patterns. Stroke and mortality rates approached 80% and 40% respectively but early treatment reduces these rates to at least 20% and 10%.  Screening guidelines have been developed to identify the patients at highest risk for BCVI (neuro exam inconsistent with findings, Horner’s syndrome, Leforte fracture, etc).  However, 20-30% of patients with these injuries do not have any identifiable clinical criteria and go unscreened until symptomatic. Liberal screening with cervical CTA is therefore valuable.  If the CTA is performed during the initial trauma scan, no more than the typical contrast load (~100cc) will be needed.  However, a return to CT for cervical CTA will require an additional 90cc of contrast, increasing the risk of contrast-induced morbidity.
Note: Any BCVI patient with neurologic symptoms should have a STROKE ALERT activated.