Learning objectives
Emergency selection Criteria of traumatized Patient at risk of neurovascular injury (arterial dissection,
venous thrombosis and AV fistulae)
Role of CTA-MRA and DSA in the diagnosis (sensitivity and specificity of different techniques) and management of the lesions (follow up and therapy)
Neuroradiological semiotics of vascular damage in different techniques (direct and indirect signs)
Diagnostic and therapeutic role of Digital Subtraction Angiography (DSA)
Background
Traumatic neurovascular injuries are rare (0,1%-2% of severe trauma),
and are associated with high rates of morbidity (32%-67%) and mortality (17%-38%),
especially if not recognized and promptly treated.
Post traumatic dissections are the main cause of stroke in young people.
Agood screening protocol can reduce injury-related strokes in patients without primary focal neurologic deficits.
(13)
PATHOPHYSIOLOGY
The central nervous system has a high sensitivity to the trauma,
and to neurovascular injuries,
that result in a diagnostic and therapeutic challenge.
Various parameters modification can break brain...
Findings and procedure details
Our CT study protocol includes basal spiral acquisition of brain and neck (also with bone HR) and MPR reconstructions of the cervical tract. The examination is completed with TCA study of the apiaortic and intracranial vessels with biphasic technique (venous afetr 40 sec for the study of collateral circulation) and MPR and MIP reconstructions. The MRI study protocol includes FLAIR-weighted mutiplanar standard T1W-T2W sequences,
GE and DWI for the study of the brain that can be completed with MRA sequences for the study of arterial...
Conclusion
Imaging findings of acute severe trauma is performed to detect treatable lesions,
involving neurovascular structures of head and neck,
before secondary neurologic damage occurs.
Usually CT and CTA imaging are the best and faster technique to study this patients,
in wich parenchimal,
bones and vascular damages may occur.
Detecting the vascular lesions allow a prompt treatment.
Sometime the best approach is the endovascular one,
after a multidisciplinary case discussion.
Personal information
Dr Giuseppina Sanfilippo
Resident in training.
Neuroradiology Section.
Department of Radiology and Neuroradiology diagnostic and interventional,
IRCCS Policlinico San Matteo,
piazzale Golgi 19,
27100 Pavia,
Italy
Email:
[email protected]
Dr Anna Maria Simoncelli
Neuroradiology Section.
Department of Radiology and Neuroradiology diagnostic and interventional,
IRCCS Policlinico San Matteo,
piazzale Golgi 19,
27100 Pavia,
Italy
Email:
[email protected]
Dr Elvis Lafe
Neuroradiology Section.
Department of Radiology and Neuroradiology diagnostic and interventional,
IRCCS Policlinico San Matteo,
piazzale Golgi 19,
27100 Pavia,
Italy
Email:
[email protected]
Dr Federico Zappoli Thiryon
Neuroradiology Section....
References
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Marín-Fernández AB,et al.
Posttraumatic carotid-cavernous fistula: Pathogenetic mechanisms,
diagnostic management and proper treatment.
A case report.
J Clin Exp Dent.
2016; 8(2): e226–e229
Galyfos G,et al.Traumatic Carotid Artery Dissection: A Different Entity without Specific Guidelines.
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32,
No.
1,
2016
Wintermark M,
et al.
Imaging Evidence and Recommendations for Traumatic Brain Injury: Conventional Neuroimaging Techniques .
Journal...
