Cerebrovascular Complications in Early Survivors of Civilian Penetrating Brain Injury
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ORIGINAL WORK
Cerebrovascular Complications in Early Survivors of Civilian Penetrating Brain Injury Ali Mansour1,3* , Andrea Loggini1, Faten El Ammar1, Daniel Ginat2, Issam A. Awad3, Christos Lazaridis1,3, Christopher Kramer1,3, Valentina Vasenina3, Sean P. Polster3, Anna Huang4, Henry Olivera Perez4, Paramita Das3, Peleg M. Horowitz3, Tanya Zakrison5, David Hampton5, Selwyn O. Rogers5 and Fernando D. Goldenberg1,3 © 2020 Springer Science+Business Media, LLC, part of Springer Nature and Neurocritical Care Society
Abstract Background: This study investigates the presence of cerebrovascular injuries in a large sample of civilian penetrating brain injury (PBI) patients, determining the prevalence, radiographic characteristics, and impact on short-term outcome. Methods: We retrospectively reviewed patients with PBI admitted to our institution over a 2-year period. Computed tomography head scans, computer tomography angiograms and venograms of the intracranial vessels were evaluated to determine the wound trajectory, intracranial injury characteristics, and presence of arterial (AI) and venous sinus (VSI) injuries. Demographics, clinical presentation, and treatment were also reviewed. Discharge disposition was used as surrogate of short-term outcome. Results: Seventy-two patients were included in the study. The mechanism of injury was gunshot wounds in 71 patients and stab wound in one. Forty-one of the 72 patients (60%) had at least one vascular injury. Twenty-six out of 72 patients suffered an AI (36%), mostly pseudoaneurysms and occlusions, involving the anterior and middle cerebral arteries. Of the 72 patients included, 45 had dedicated computed tomography venograms, and of those 22 had VSI (49%), mainly manifesting as superior sagittal sinus occlusion. In a multivariable regression model, intraventricular hemorrhage at presentation was associated with AI (OR 9.9, p = 0.004). The same was not true for VSI. Conclusion: Acute traumatic cerebrovascular injury is a prevalent complication in civilian PBI, frequently involving both the arterial and venous sinus systems. Although some radiographic features might be associated with presence of vascular injury, assessment of the intracranial vasculature in the acute phase of all PBI is essential for early diagnosis. Treatment of vascular injury remains variable depending on local practice. Keywords: Cerebrovascular injury, Penetrating brain injury, Neurotrauma Background Traumatic cerebrovascular injury is a common potential complication of penetrating brain injury (PBI) [1, 2]. The current guidelines are almost two decades old and are based only on eight retrospective studies from the 1990s *Correspondence: [email protected] 1 Neurosciences Intensive Care Unit, Neurocritical Care, Department of Neurology, University of Chicago Medicine and Biological Sciences, 5841 S. Maryland Ave, MC 2030, Chicago, IL 60637‑1470, USA Full list of author information is available at the end of the article
[3]. The studies’ findings are vague and their recommendations are
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