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2013 ; 53
(9
): 573-9
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Traumatic cerebrovascular injury following severe head injury: proper diagnostic
timetable and examination methods
#MMPMID24067766
Onda H
; Fuse A
; Yamaguchi M
; Igarashi Y
; Watanabe A
; Suzuki G
; Hashizume A
; Yokota H
Neurol Med Chir (Tokyo)
2013[]; 53
(9
): 573-9
PMID24067766
show ga
Traumatic cerebrovascular injury (TCVI) is a serious complication of severe head
injury, with a high mortality rate. To establish a proper treatment strategy for
TCVI, we investigated patients with a high risk of TCVI according to the
Guidelines for the Management of Severe Head Injury (hereafter "the Guidelines")
to elucidate the validity of the criteria for TCVI in the Guidelines and the
appropriate screening timing and methods. Of those transported to our facility
between December 2008 and June 2012, 67 individuals with a high risk of TCVI were
evaluated to reveal the proper timing and methods of vascular evaluation. Of the
67 patients, 21 had a diagnosis of TCVI based on cerebral angiography,
three-dimensional computed tomography angiography (3DCTA), or magnetic resonance
imaging (MRI), accounting for 6.4% of all patients with severe head injury and as
high as 31.3% of patients with a high risk of TCVI according to the Guidelines.
In addition, according to the Glasgow Outcome Scale (GOS), outcomes were three
deaths due to primary brain injury, six cases of persistent vegetative state,
five cases of severe disability, three cases of moderate disability, and four
cases of good recovery. Although 3DCTA is a simple and convenient diagnostic
method, cerebral angiography is necessary to evaluate dissecting lesions. If
patients have any signs or symptoms of TCVI, as described in the Guidelines,
cerebral angiography or 3DCTA should be performed as an initial screening method
within 72 hours of admission, followed by cerebral angiography on postadmission
Day 14 ± 2 to prevent failed diagnosis.