Value of angiography in head trauma.

Abstract

HomeRadiologyVol. 78, No. 6 PreviousNext ArticlesValue of Angiography in Head TraumaEugene V. Leslie, Bernard H. Smith, John G. ZollEugene V. Leslie, Bernard H. Smith, John G. ZollEugene V. LeslieBernard H. SmithJohn G. ZollPublished Online:Jun 1 1962https://doi.org/10.1148/78.6.930MoreSectionsPDF ToolsImage ViewerAdd to favoritesCiteTrack CitationsPermissionsReprints ShareShare onFacebookTwitterLinked In AbstractCerebral angiography is a reasonably safe procedure which affords a precise diagnosis in a multiplicity of post-traumatic entities. While its application in any given case rests upon sound clinical judgment, increased use of this method is urged. Voris (1) in 1955 stated that it was often difficult to diagnose sub- and extradural hematomata. He further indicated that the presence of an intracerebral hematoma after trauma was not easily recognized, but that, if a burr hole exploration were unrevealing, the brain should be cautiously explored with cannula. It is fair to say that in most instances these hematomata are readily identified and localized angiographically. Carton (2), making a plea for increased use of this modality in 1959, stressed his dissatisfaction with trephination as the approach to intracranial bleeding in acute trauma. Fasiani (3) and Campbell and Campbell (4) have also emphasized the simplicity, safety, and precision of angiography in the diagnosis and localization of a wide variety of lesions in cases of head injury. Hancock's series (5) indicates that the hazard of the missed lesion, especially the intracerebral hematoma, exceeds the slight risk of angiography.Table I lists the mass lesions and other abnormalities occurring after head trauma in which arteriography is enlightening. As will be seen, one can generally distinguish angiographically the extradural from the subdural hematoma. These extracerebral hematomata can further be differentiated from the intracerebral mass lesions, namely the more severe cerebral contusions and the intracerebral hematomata. Traumatic subarachnoid hemorrhage, probably the most common cause of blood in the cerebrospinal fluid may, for example, be associated with an intracranial hematoma. In point of fact, more than one of these post-traumatic entities may often be present (6), and angiography will frequently help one to appreciate their coexistence. Post-traumatic internal carotid thrombosis is an important although uncommon entity (7). Dural sinus thrombosis following trauma is similarly important but relatively infrequent (8). Both traumatic caroticocavernous fistula and caroticojugular fistula may be the result of penetrating wounds. The former, however, is more frequently associated with basal skull fracture.Angiographic differentiation of the extracerebral hematomata is usually feasible. All have the common feature of an avascular area between the inner table of the skull and the brain.EXTRADURAL HEMATOMAExtradural hematoma is, in most instances, associated with linear fracture of the parietal or temporal bone with resultant severance of the middle meningeal artery or one of its branches. The clinical picture is usually such that immediate surgical intervention is undertaken. Occasionally, however, and, especially when the bleeding is largely venous, the clinical picture will not at once lead to the appropriate diagnosis and angiography will reveal the true situation. Figure 1 is an angiogram obtained less than twenty-four hours after trauma, although, at the time, no history of injury was available. Classically we see displacement of the anterior cerebral artery to the opposite side, medial displacement of the middle cerebral artery, and a lentiform avascular area lying extracerebrally over the convexity of the brain. This appearance, in itself, when encountered within several days of the injury, is typical of an extradural hematoma which, in dissecting the dura off the inner table, opens up a space that is thus convex inward and outward.Article HistoryPublished in print: June 1962 FiguresReferencesRelatedDetailsCited ByVoprosy neirokhirurgii imeni N.N. Burdenko, Vol. 83, No. 4Child's Nervous System, Vol. 34, No. 3Journal of Neurosurgery, Vol. 100, No. 2Neurologia medico-chirurgica, Vol. 41, No. 1Journal of Neurosurgery, Vol. 76, No. 1British Journal of Neurosurgery, Vol. 3, No. 5Journal of Neurosurgery, Vol. 66, No. 5Acta Neurochirurgica, Vol. 60, No. 1-2Surgical Neurology, Vol. 17, No. 3Acta Neurochirurgica, Vol. 55, No. 3-4Journal of Neurosurgery, Vol. 52, No. 1Neuroradiology, Vol. 17, No. 5Angiology, Vol. 27, No. 9The British Journal of Radiology, Vol. 46, No. 542Clinical Radiology, Vol. 22, No. 3Postgraduate Medicine, Vol. 42, No. 2The British Journal of Radiology, Vol. 39, No. 461Journal of Neurosurgery, Vol. 25, No. 4Radiologic Clinics of North America, Vol. 4, No. 1The British Journal of Radiology, Vol. 38, No. 455Recommended Articles RSNA Education Exhibits RSNA Case Collection Vol. 78, No. 6 Metrics Altmetric Score PDF download