Blunt Cerebrovascular Injuries (BCVI)

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BCVI: Collective incidence approximately 1% of blunt trauma admissions.

Trauma patients with any of the following signs/symptoms should be considered to have BCVI until proven otherwise:

• Arterial hemorrhage from neck, mouth, nose, ears
• Large or expanding cervical hematoma
• Cervical bruit in patient < 50 years old
• Focal or lateralizing neurologic deficit, including hemiparesis
• Transient ischemic attack
• Horner’s syndrome (Oculosympathetic paresis)
• Vertebrobasilar insufficiency
• Evidence of cerebral infarction on CT or MRI
• Neurologic deficit that is incongruous with CT or MRI findings

1. No published prospective randomized clinical trials in BCVI that have generated class I data.
2. Recommendations therefore based on observational studies and expert opinion.

Blunt Carotid and Vertebral Injury Grading Scale 

Injury Grade	Description
I	Luminal irregularity or dissection with < 25% luminal narrowing
II	Dissection or intramural hematoma with ≥ 25% luminal narrowing, intraluminal thrombus, or raised intimal flap
III	Pseudoaneurysm
IV	Occlusion
V	Transection with free extravasation

https://www.westerntrauma.org/wp-content/uploads/2020/08/Screening-for-and-Treatment-of-Blunt-Cerebrovascular-Injuries-Algorithm_FINAL.svg