case: cerebrovascular trauma

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It is indeed about the vertebral artery.
Thank you for the advice.

C. Ursic, MD
general surgeon

On Tue, Nov 24, 2009 at 6:35 PM, McSwain, Norman E <nmcswai at tulane.edu>wrote:

> Bill Bromberg just brought to my attention that this is vertebral not
> carotid as I remembered the post. If that is correct then I would do
> nothing.
>
> 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 McSwain, Norman E
> Sent: Tue 11/24/2009 9:53 PM
> To: Trauma-List [TRAUMA.ORG]
> Subject: RE: case: cerebrovascular trauma
>
>
> 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
> >
> >
> >
> > --
> >
> > 'The only true knowledge
> > Is the knowledge of our own ignorance.'
> > -Socrates
> > --
> > trauma-list : TRAUMA.ORG <http://trauma.org/>
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> >
> > Sent via BlackBerry by AT&T
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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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>



-- 
'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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