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

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  1. Title: Blunt Cerebrovascular Injuries (BCVI)
  2. Author:  Michigan Medicine
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  4. License: “CC BY-NC 4.0”

Blunt Cerebrovascular Injuries (BCVI),  Michigan Medicine, Dept of Surgery,  “CC BY-NC 4.0”


Biffl WL, et al. Western Trauma Association Critical Decisions in Trauma: Screening for and Treatment of Blunt Cerebrovascular Injuries. J Trauma 2009;67:1150-1153.

Bromberg WJ, et al. Blunt Cerebrovascular Injury Practice Management Guidelines, Eastern Association for the Surgery of Trauma, 2007

Last reviewed: 09 June 2021