Bissl et al listed criteria for when to perform carotid and vertebral arteriography after blunt trauma to the head and neck. A high index of suspicion may be needed to detect subtle vascular injuries that may benefit from surgical intervention or anticoagulation. The authors are from the University of Colorado.


Features of the traumatic injury:

(1) severe cervical hyperextension

(2) severe cervical rotation

(3) severe cervical hyperflexion

(4) near hanging or strangulation

(5) seat belt abrasion over the anterior neck

(6) blunt soft tissue injury over the anterior neck

(7) closed head injury


Physical findings:

(1) hemorrhage of possible arterial origin from mouth, nose, ears or wounds

(2) expanding cervical hematoma

(3) bruit over a carotid artery in a patient < 50 years of age

(4) evidence of a cerebral infarction on imaging study of the brain

(5) unexplained or incongruous central or lateralizing neurologic deficits

(6) transient ischemic attack (TIA)

(7) amaurosis fugax

(8) Horner's syndrome

(9) displaced midface fracture

10) complex mandibular fracture

(11) signs of diffuse axonal injury

(12) basilar skull fracture involving the carotid canal

(13) fracture of the body of a cervical vertebra

(14) significant swelling in the neck with altered mental status


Patients with pertinent findings underwent four vessel cerebral arteriography.


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