Diagnosis of blunt cerebrovascular injuries

PURPOSE OF REVIEW: Blunt cerebrovascular injuries (BCVI) are being increasingly recognized. The optimal criteria for screening, and the best diagnostic test, remain a matter of controversy. This review analyzes the available literature to propose management guidelines for the diagnosis of BCVI. RELEVANT FINDINGS: A number of centers are screening asymptomatic patients for BCVI. The criteria vary from center to center. The incidence of injuries diagnosed is proportional to the breadth of screening criteria. Noninvasive diagnostic modalities such as duplex ultrasonography, computed tomographic angiography, and magnetic resonance angiography have been proposed as screening tools. Although they are all capable of identifying many injuries, prospective comparisons reveal inaccuracies. SUMMARY: Screening for BCVI is appropriate. Institutions should adopt formal criteria, recognizing that more restrictive criteria are likely to miss injuries. Noninvasive modalities must be used with caution, because they have been found to be inferior to arteriography.