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case: cerebrovascular trauma

McSwain, Norman E nmcswai at tulane.edu
Wed Nov 25 03:53:58 GMT 2009


But what do the trauma surgeons want? Taking care of this patient is what the trauma surgeon does, not the neurosurgeons. This patient should have had either stint placement or surgical vascular repair within 4 hours after the initial injury if one would expect to reduce or prevent neurological damage. I certainly would not have waited to get an MRA. He does not need antigoagulated. He needs fixed.
Norman
 
Norman McSwain MD
Trauma Director, Spirit of Charity Trauma Center
Professor of Surgery, Tulane University
New Orleans LA
504 988 5111
norman.mcswain at tulane.edu <mailto:norman.mcswain at tulane.edu> 

________________________________

From: trauma-list-bounces at trauma.org on behalf of caesar ursic
Sent: Tue 11/24/2009 3:05 PM
To: Trauma-List [TRAUMA.ORG]
Subject: Re: case: cerebrovascular trauma



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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