TY - JOUR
T1 - Cerebrovascular Complications in Early Survivors of Civilian Penetrating Brain Injury
AU - Mansour, Ali
AU - Loggini, Andrea
AU - El Ammar, Faten
AU - Ginat, Daniel
AU - Awad, Issam A.
AU - Lazaridis, Christos
AU - Kramer, Christopher
AU - Vasenina, Valentina
AU - Polster, Sean P.
AU - Huang, Anna
AU - Olivera Perez, Henry
AU - Das, Paramita
AU - Horowitz, Peleg M.
AU - Zakrison, Tanya
AU - Hampton, David
AU - Rogers, Selwyn O.
AU - Goldenberg, Fernando D.
N1 - Funding Information:
We wish to acknowledge the support of the Department of Neurology, the Department of Radiology, Section of Neuroradiology, and the Department of Surgery, Sections of Neurosurgery and Trauma at the University of Chicago.
PY - 2020
Y1 - 2020
N2 - Background: This study investigates the presence of cerebrovascular injuries in a large sample of civilian penetrating brain injury (PBI) patients, determining the prevalence, radiographic characteristics, and impact on short-term outcome. Methods: We retrospectively reviewed patients with PBI admitted to our institution over a 2-year period. Computed tomography head scans, computer tomography angiograms and venograms of the intracranial vessels were evaluated to determine the wound trajectory, intracranial injury characteristics, and presence of arterial (AI) and venous sinus (VSI) injuries. Demographics, clinical presentation, and treatment were also reviewed. Discharge disposition was used as surrogate of short-term outcome. Results: Seventy-two patients were included in the study. The mechanism of injury was gunshot wounds in 71 patients and stab wound in one. Forty-one of the 72 patients (60%) had at least one vascular injury. Twenty-six out of 72 patients suffered an AI (36%), mostly pseudoaneurysms and occlusions, involving the anterior and middle cerebral arteries. Of the 72 patients included, 45 had dedicated computed tomography venograms, and of those 22 had VSI (49%), mainly manifesting as superior sagittal sinus occlusion. In a multivariable regression model, intraventricular hemorrhage at presentation was associated with AI (OR 9.9, p = 0.004). The same was not true for VSI. Conclusion: Acute traumatic cerebrovascular injury is a prevalent complication in civilian PBI, frequently involving both the arterial and venous sinus systems. Although some radiographic features might be associated with presence of vascular injury, assessment of the intracranial vasculature in the acute phase of all PBI is essential for early diagnosis. Treatment of vascular injury remains variable depending on local practice.
AB - Background: This study investigates the presence of cerebrovascular injuries in a large sample of civilian penetrating brain injury (PBI) patients, determining the prevalence, radiographic characteristics, and impact on short-term outcome. Methods: We retrospectively reviewed patients with PBI admitted to our institution over a 2-year period. Computed tomography head scans, computer tomography angiograms and venograms of the intracranial vessels were evaluated to determine the wound trajectory, intracranial injury characteristics, and presence of arterial (AI) and venous sinus (VSI) injuries. Demographics, clinical presentation, and treatment were also reviewed. Discharge disposition was used as surrogate of short-term outcome. Results: Seventy-two patients were included in the study. The mechanism of injury was gunshot wounds in 71 patients and stab wound in one. Forty-one of the 72 patients (60%) had at least one vascular injury. Twenty-six out of 72 patients suffered an AI (36%), mostly pseudoaneurysms and occlusions, involving the anterior and middle cerebral arteries. Of the 72 patients included, 45 had dedicated computed tomography venograms, and of those 22 had VSI (49%), mainly manifesting as superior sagittal sinus occlusion. In a multivariable regression model, intraventricular hemorrhage at presentation was associated with AI (OR 9.9, p = 0.004). The same was not true for VSI. Conclusion: Acute traumatic cerebrovascular injury is a prevalent complication in civilian PBI, frequently involving both the arterial and venous sinus systems. Although some radiographic features might be associated with presence of vascular injury, assessment of the intracranial vasculature in the acute phase of all PBI is essential for early diagnosis. Treatment of vascular injury remains variable depending on local practice.
KW - Cerebrovascular injury
KW - Neurotrauma
KW - Penetrating brain injury
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U2 - 10.1007/s12028-020-01106-y
DO - 10.1007/s12028-020-01106-y
M3 - Article
AN - SCOPUS:85092157646
JO - Neurocritical Care
JF - Neurocritical Care
SN - 1541-6933
ER -