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case: cerebrovascular trauma

caesar ursic cmursic at gmail.com
Tue Nov 24 21:05:46 GMT 2009


Dr. Mattox:
I agree with you.  However, the subsequent MRAngio shows the clot and
dissection in this patient.  Would you still get formal angio because you
feel this is a false positive by the MRA?

Assuming the formal angio shows this lesion - then what?  Neurosurgeons do
not want him anticoagulated.

C. Ursic, MD
General Surgeon




On Tue, Nov 24, 2009 at 1:46 AM, <kmattox at aol.com> wrote:

> 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 <http://trauma.org/>]
>  ReplyTo: Trauma-List [TRAUMA.ORG <http://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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> Is the knowledge of our own ignorance.'
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-- 
'Twas brillig, and the slithy toves
Did gyre and gimble in the wabe:
All mimsy were the borogoves,
And the mome raths outgrabe.


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