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In terms of BCVI grading, 6 of the 11 patients sustained grade IV injuries, which is associated with a 44% risk of stroke and a 22% risk of mortality.
Presentation of patients with BCVI is widely variable, ranging from nonspecific symptoms such as headache or neck pain to severe focal paralysis resulting from ischemic stroke.
The diagnostic picture of BCVI is often complicated due to the variability of signs and symptoms indicating injury.
The gold standard for diagnosing BCVI (including dissections, occlusions, and pseudoaneurysm) has been accepted to be four-vessel cerebral angiogram [3, 4, 6,8].
Present recommendations indicate that an angiogram may still be warranted if there is a high suspicion based on neurologic exam findings and a negative CTA but, in the study by Berne et al , there were no patients with a negative CTA that were later diagnosed with BCVI. Positive CTA often requires follow-up with angiography as the positive predictive value of CTA can range from 36 to 55% [7,10].
Therefore, both the Western Trauma Association and Eastern Association for the Surgery of Trauma recommend against using duplex ultrasound as a sole screening method for BCVI [8,9].
Stroke caused by BCVI occurs within the first 24 hours 25-50% of the time .
Imaging modalities to diagnose BCVI include Duplex ultrasound, CTA, MRI, magnetic resonance angiography (MRA), and digital subtractive angiography (DSA).
Generally, DSA is considered the "gold standard" for BCVI detection; however it is an invasive procedure with inherent risks .
To prevent thrombosis, embolization, and cerebral intracranial vessel clot propagation, the current initial recommendation for the management of BCVI is antithrombotic therapy .
Making the diagnosis of cerebral ischemia caused by BCVI requires a high index of suspicion.
OU Medicine contributed its patient data concerning BCVIs to the study, which included more than 30 such institutions around the country.
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