Blunt Cervical Injury Research Articles

Computed tomography vs. magnetic resonance imaging in unstable cervical spine injuries.

This study aimed to investigate the role of computed tomography (CT) in identifying missed unstable blunt cervical injuries. Patients admitted to the emergency department between June 2014 and June 2018 with a diagnosis of blunt cervical trauma were included in this study. All participants underwent cervical magnetic resonance imaging (MRI) after an initial cervical CT investigation. All imaging results were reviewed, and decisions were taken by the consensus of a team consisting of an emergency medicine specialist, a neuroradiologist, and a neurosurgeon. Other variables included age, sex, the Glasgow Coma Scale, medical comorbidities, multi-trauma, neurological deficits, accompanying intracranial hemorrhage, extremity fractures, and the mechanism of the injury. Data for 195 patients were analyzed. The mean (±standard deviation) age of the participants was 47.34±21.90 years, and 140 (71.8%) were males. Eighteen patients (9.2%) were below age <18. The most frequent mechanism of injury was fall from height (n=100; 51.3%). Using MRI as the gold standard, the sensitivity of CT in diagnosing unstable cervical injury was 77.7% (95% CI [67.1-86.1]), while its specificity was 100.0% (95% CI [59.0-100.0]). Although computed tomography is relatively good in diagnosing unstable cervical injuries, its sensitivity in detecting positive cases is not as successful. Thus, the use of MRI in patients with an unstable injury seems to be warranted.

Imaging of the cervical spine injury in elderly patients

Background: The RCR and NICE recommends developing local protocol for primary imaging modality for cervical spine (CSPN) assessment of blunt cervical injury in elderly patients (>65 yrs). Literature suggests young elderly (65 – 75yrs) are less likely to need further imaging than old elderly (>75yrs). Distinction reflects observed differences in functional decline, trauma mortality rates and osteoporosis

Traumatic carotid artery occlusion following blunt cervical injury

Two cases of overlooked, traumatic unilateral occlusion of the carotid artery are reported. Postmortem revealed occlusion of the internal carotid artery in one case and that of the common carotid artery in another. The progression of the morbid state, along with the management with emphasis on the significance of the carotid angiogram and follow-up repeated computed tomography are mentioned. Although traumatic occlusion of the common carotid artery is not as common as that of the internal carotid artery, both entities are well known to produce morbidity and mortality.

Aneurysm of the thyrocervical trunk after blunt cervical injury

A healthy, 22-year-old male blacksmith was admitted to the emergency department with a 5-cm-long wound in the right supraclavicular region, having been stuck by a piece of iron weighing I.1 kg. He had paraesthesiae of the inner border of the arm including the three ulnar fingers. The radial and carotid pulses were intact. There was no history of loss of consciousness. X-rays of the shoulder and right clavicle did not reveal a fracture. The wound was cleaned and sutured, and the patient was discharged from hospital after 2 days. There was no follow-up. Four months later he was referred to the orthopaedic department with persistent pain and reduction of movement of the right shoulder and neck. A torticollis towards the right was noted with accompanying reduction of movement of the neck and right shoulder and there were still paraesthesiae in the three ulnar fingers. No other neurological deficits were encountered and physiotherapy was initiated. Five months after the trauma, he developed a right Homer’s syndrome and a facial palsy. MR-scans of the cervical column and right brachial plexus were normal, but angiography of the brachiocephalic trunk revealed an aneurysm of the right thyrocervical trunk near its origin, extending for 2 cm (Fi,r~lrr, 1). Resection of the aneurysm was performed and the Horner’s syndrome gradually subsided over the following 7 days, but the facial palsy and the ulnar pararsthesiae persisted. Discussion

Carotid and vertebral artery occlusion after blunt cervical injury: the role of MR angiography in early diagnosis.

The early diagnosis of cervical vascular trauma is critical in the prevention of cerebral ischemia. Traumatic blunt carotid or vertebral artery dissection is rare and frequently associated with other injuries. Diagnosis is often delayed, limiting treatment options and contributing to a poor outcome. The clinical findings and investigation of 14 patients are presented with special reference to the last three who had magnetic resonance imaging angiography. Treatment options are discussed and it is suggested that with modern methods of investigation and management, the prognosis of this condition may be improved.