case: cerebrovascular trauma

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According to paper preseNted at AAST this year, do not rely on CTA of neck vessels.  Do formal arteriogram.  

K


------Original Message------
From: caesar ursic
Sender: trauma-list-bounces at trauma.org
To: Trauma-List [TRAUMA.ORG]
ReplyTo: Trauma-List [TRAUMA.ORG]
Sent: Nov 24, 2009 3:08 AM
Subject: case: cerebrovascular trauma

20-ish male restrained driver crashes head on into palm tree (yes, really).
no airbags, but restrained by lap and shoulder harness.

Intoxicated but cooperative.
Complaining of neck pain only.

Hemodynamically normal on arrival and subsequently.
Neck exam:  bruise across right neck in the usual location from the
restraint belt.  Tender posterior neck.
Neurologic exam: normal.

CT scan of cervical spine:  fractured c-5 body and lamina, 3mm c-5 on c-6
anterior subluxation.  No significant soft tissue abnormalities.
CT Angio of neck: right vertebral artery focally stenotic at c-6 but patent.
all other vessels are normal.
CT of brain (noncontrast): normal
MRI of c-spine: no ligamentous damage; right vertebral artery with small
clot and intimal dissection, but patent.

Neurosurgeon wants to stabilize his fractured c-spine (i.e. operate).  This
will be done via anterolateral approach.

Plan?

C. Ursic, MD
general surgeon



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