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Screening Criteria for Blunt Cerebrovascular Injury

Appendix H: Screening criteria for blunt cerebrovascular injury (BCVI)

Screening criteria for BCVI

Injury mechanism

  • Severe cervical hyperextension/rotation or hyperflexion, particularly if associated with
    • Displaced mid-face or complex mandibular fracture
    • Closed head injury consistent with diffuse axonal injury
  • Near hanging resulting in anoxic brain injury
Physical signs

  • Seat belt abrasion or other soft tissue of the anterior neck resulting in significant swelling or altered mental status
Fracture in proximity to internal carotid or vertebral artery

  • Basilar skull fracture involving the carotid canal
Denver modification of screening criteria

Signs/symptoms of BCVI

  • Arterial hemorrhage
  • Cervical bruit
  • Expanding cervical hematoma
  • Focal neurological deficit
  • Neurologic examination incongruous with CAT scan findings
  • Ischemic stroke on secondary CAT scan
Risk factors for BCVI

  • High-energy transfer mechanism with 
    • Lefort II or III fracture
    • Cervical spine fracture patterns: subluxation, fractures extending into the transverse foramen, fractures of the C1-C3
    • Basilar skull fracture with carotid canal involvement
    • Diffuse axonal injury with GCS ≤6
    • Near hanging with anoxic brain injury
SOURCE: Screening Criteria for Blunt Cerebrovascular Injury ( )
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