SAQ 367 – Trauma – blunt cerebrovascular injury
Model Answer
Trauma – blunt cerebrovascular injury.
a. Vessels
- Internal carotid artery dissection.
- Vertebral artery dissection, particularly as it passes through the transverse foramina.
b. Clinical features
| Internal carotid dissection | Vertebral artery dissection |
|---|---|
| Unilateral headache, usually frontotemporal and severe enough to mimic SAH or migraine. | Headache, typically occipital. |
| Anterior neck pain. | Posterior neck pain. |
| Partial Horner syndrome, with miosis and ptosis. | Facial paraesthesia. |
| Cranial nerve palsies. | Lateral medullary syndrome, diplopia, or ataxia. |
c. Screening
- Denver screening criteria, divided into risk factors and signs/symptoms.
d. Risk factors
- Neck trauma, including cervical spine fractures involving the transverse foramen, cervical spine subluxation, severe facial injury, or base-of-skull fracture involving the carotid canal.
- Cervical manipulation.
- Connective tissue disease.
- Near hanging with anoxic brain injury.
e. Suggestive signs or symptoms
- Focal neurological deficit.
- Cervical bruit or thrill.
- Infarct on head CT.
- Expanding neck haematoma.
- Neurological examination inconsistent with the head CT findings.
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