Blunt CVI

Question 1

Injury mechanisms high risk for BCVI?

Answer 1

Hyper extension/rotation
Hyperflexion
Direct force

Question 2

What patients require screening for BCVI?

Answer 2

• Neurologic signs not explained by known injury
• epistaxis from arterial source
• bleeding from blunt intraoral injury
• GCS < 8
• Petrous bone #
• DAI
• C spine # through foramen, C1-C3,or rotational mechanism
• Lefort 2/3

Question 3

What is the preferred screening modality for BCVI?

Answer 3

CTA and consider angiography if uncertainty remains.

Do not use MRI or U/S.

Question 4

Denver grading scale for blunt CVI?

Answer 4

Grade 1 - intimal irregularity with < 25% narrowing
Grade 2 - Dissection or intramural hematoma with > 50% narrowing
Grade 3 - pseudoaneurysm
Grade 4 - occlusion
Grade 5 - transection with extravasation.

Question 5

Management of BCVI by grade?

Answer 5

1/2 - heparin or aspirin depending on bleeding risk and other injuries.

3- surgery if accessible or interventional

4- consider restoring flow if early injury but not with fixed Neuro defects

5 - OR to control hemorrhage.

Question 6

When do you get follow up imaging in BCVI?

Answer 6

7 days at which point anticoagulation can be stopped if the injuries have resolved.