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NEUROLOGY + NEUROSURGERY

BLUNT CVA

Non penetrating injury in trauma patients that may cause injury to internal carotid or vertebral artery that may cause stroke in trauma patients

Stem - MVA + neck pain, Neck pain + headache carrying child on shoulders
PromptRisk factors for blunt CVA
ResponseNeck trauma
  • C spine injuries (Fractures involving transverse foramen, C spine subluxation)
  • Base of skull #’s
  • Severe facial injuries
Cervical manipulation
Connective tissue disease
Near hanging with anoxic brain injury
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PromptSigns/symptoms of blunt CVA
ResponseFocal neurologic deficit
Cervical bruit or thrill
Expanding neck haematoma
Neuro exam inconsistent with CT brain
Infarct on CT brain
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PromptScreening tool for blunt CVA
ResponseDenver screening criteria - risk factors and sings/symptoms
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PromptImaging in blunt CVA
ResponseNarrowed lumen of L carotid (coronal)
Crescent shaped irregularity in L carotid artery consistent with thrombus (Axial)
Outpouching from L carotid superior to narrowing likely associated aneurysm
Filling defect L carotid artery
Reduced contrast in teritorises distal to L carotid
No ICH as alternative for symptoms
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PromptList the 2 major vessels involved in blunt CVA
ResponseInternal carotid artery dissection
Vertebral artery dissection (As it passes through transverse foramina)
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PromptInternal carotid dissection features
ResponseMore common than vertebral artery, more commonly injured from external pressure
Unilateral headache (Frontotemporal) - severe, may mimic SAH/previous migraine
Anterior neck pain
Partial horner syndrome (Ptosis and miosis)
Cranial nerve palsies
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PromptVertebral artery dissection
ResponseHeadache (occipital, bilateral)
Posterior neck pain
Facial parasthesia
Lateral medullary syndrome (basic description - ipsilateral cranial nerve, contralateral sensory below the face)
Diplopia, ataxia (Cerebellar signs)
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PromptManagement options for dissection
ResponseSmall area of thrombus with no flap = antiplatelet
Moderate to large thrombus with/without flap = anticoagulation (heparin or DOAC)
Persistent ischaemia despite medical management = Surgical management with stent
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