دورية أكاديمية
Diagnosis, treatment, and outcome of blunt carotid arterial injuries.
| العنوان: | Diagnosis, treatment, and outcome of blunt carotid arterial injuries. |
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| المؤلفون: | Kraus RR; Department of Surgery, University of Illinois College of Medicine at Peoria, USA., Bergstein JM, DeBord JR |
| المصدر: | American journal of surgery [Am J Surg] 1999 Sep; Vol. 178 (3), pp. 190-3. |
| نوع المنشور: | Journal Article |
| اللغة: | English |
| بيانات الدورية: | Publisher: Excerpta Medica Country of Publication: United States NLM ID: 0370473 Publication Model: Print Cited Medium: Print ISSN: 0002-9610 (Print) Linking ISSN: 00029610 NLM ISO Abbreviation: Am J Surg Subsets: MEDLINE |
| أسماء مطبوعة: | Publication: Belle Mead, NJ : Excerpta Medica Original Publication: New York. |
| مواضيع طبية MeSH: | Carotid Artery Injuries*/diagnosis , Carotid Artery Injuries*/mortality , Carotid Artery Injuries*/therapy , Wounds, Nonpenetrating*/diagnosis , Wounds, Nonpenetrating*/mortality , Wounds, Nonpenetrating*/therapy, Adult ; Anticoagulants/therapeutic use ; Diagnostic Imaging ; Female ; Humans ; Incidence ; Male ; Retrospective Studies ; Stroke/prevention & control ; Treatment Outcome |
| مستخلص: | Background: Blunt carotid injuries are rare, and present late with devastating strokes. A sizeable single-institution descriptive report could help characterize the injury and its diagnosis and treatment. Method: We performed a retrospective review of blunt carotid artery injuries from May 1988 to December 1997 at a level I trauma center. Chart review consisted of demographics, mechanism of injury, associated injuries, diagnostic modalities, initial neurologic status, treatment, and outcome. Discharge outcome was classified as "good" (normal-mild deficit), "fair" (needing daily assistance), "poor" (institutionalized), or "dead." Results: During the study period 16 patients sustained a carotid artery injury. Mean age was 35 years and 63% were female. Vehicular trauma was the most common mechanism of injury (81%), followed by assaults (13%). Dissection was the most common injury (75%), with one quarter having an associated pseudoaneurysm. Initial neurologic presentation was normal in 31% and Glasgow Coma Score was < 13 in 31% (including 13% in coma). Eventual hemispheric symptoms developed in 81%. Associated injuries were present in 94%, commonly head (44%) and chest (50%). Duplex ultrasound accurately identified the injury in all patients (5 of 5) when used. Anticoagulation (88%) had no complications. Observation and therapeutic embolization each resulted in 1 fatal stroke. A third patient, with worsening deficits on heparin, died after carotid ligation, for an overall mortality of 19%. There were no deaths in the 13 patients treated by anticoagulation alone. Six patients (38%) had a "good" neurologic outcome, five (31%) "fair," and two (13%) "poor." Initial neurologic presentation, associated injuries, and mechanism of injury did not appear to correlate with these outcome categories. Conclusions: These uncommon injuries should be suspected in the presence of head and/or chest injuries, basilar skull fracture, or coma (particularly if the computed tomography scan is unremarkable). Presentation may be varied, but most patients eventually develop hemispheric symptoms. Duplex ultrasound detects many of these injuries, but this does not demonstrate its utility as a screening tool. Anticoagulant therapy appears to be associated with a better outcome than expectant or occlusive therapy. |
| المشرفين على المادة: | 0 (Anticoagulants) |
| تواريخ الأحداث: | Date Created: 19991020 Date Completed: 19991104 Latest Revision: 20220331 |
| رمز التحديث: | 20221213 |
| DOI: | 10.1016/s0002-9610(99)00157-9 |
| PMID: | 10527436 |
| قاعدة البيانات: | MEDLINE |
Full Text Finder | تدمد: | 0002-9610 |
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| DOI: | 10.1016/s0002-9610(99)00157-9 |