Diagnosis and Management of Pediatric Blunt Cerebrovascular Injuries: A Narrative Review

Background/Objectives: While standardized guidelines have been established for the evaluation and management of blunt cerebrovascular injuries (BCVIs) in adults, there remains a paucity of standardized guidelines for BCVIs in pediatric populations. Shortcomings in treatment algorithms also persist as uncertainty remains about the optimal approach to manage these cases. A review of the literature was performed to compile the current evidence and provide recommendations based on current overarching trends. Methods: PubMed was queried for studies related to the diagnosis and management of BCVIs in the pediatric population. Prevalence, mechanism of injury (MOI), screening criteria, diagnostic modality, vascular injuries identified, associated injuries, treatment, and patient risk factors were analyzed. Results: The Utah and McGovern criteria were the first tools developed for screening BCVIs in pediatric patients. Among all screening tools, the high sensitivity and specificity of the McGovern criteria support its use as the optimal screening strategy to date for pediatric patients. Given the high prevalence of high-energy MOI, observation is the most common approach chosen due to contraindications to medical therapy. Antiplatelet agents showed no significant differences in stroke prevention or hemorrhagic complications compared to anticoagulation. Strokes represent the primary source of morbidity among pediatric patients with BCVIs. Conclusions: Pediatric BCVIs represent an uncommon but clinically significant consequence of blunt trauma, with a significant risk for ischemic stroke and neurologic morbidity. Early recognition through appropriate screening with pediatric-specific screening criteria, CTA imaging, and timely initiation of grade-based treatment can help mitigate injury progression and complications.