Blunt Traumatic Brain Injury Patients: A Role for CT Angiography of the Head to Evaluate Non-Traumatic Etiologies?

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Blunt Traumatic Brain Injury Patients: A Role for CT Angiography of the Head to Evaluate Non-Traumatic Etiologies?

World Neurosurg. 2017 Feb 14;:

Authors: Nguyen H, Doan N, Gelsomino M, Shabani S

Abstract
BACKGROUND: In the setting of trauma, the etiology of intracranial hemorrhage (ICH) is frequently attributed to the physical, traumatic event. Caution should still be directed towards non-traumatic (or spontaneous) etiologies responsible for the trauma, such as hypertension, cerebral amyloid angiopathy, aneurysms, vascular malformation, and hemorrhagic infarcts. The role for immediate CT angiography (CTA) remains controversial to evaluate for non-traumatic etiologies.
METHODS: A systematic review of the available literature in Medline PubMed database.
RESULTS: With the available literature, only 12 patients with TBI received CTA head which either revealed a vascular malformation and/or altered clinical management due to concerns of a vascular malformation. The ICH in 11 patients were attributed to rupture of a cerebral aneurysm; the other patient received a diagnostic angiogram that was negative.
CONCLUSION: ICH in TBI patients appears to be vastly associated with the traumatic event. Only rare cases have been attributed to aneurysmal rupture. None have been associated with arteriovenous malformation. Nevertheless, clinical vigilance remains reasonable, especially in younger patients and those with hemorrhage within the subarachnoid cisterns or Sylvain fissure.

PMID: 28213195 [PubMed - as supplied by publisher]

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