Blunt Craniocervical Trauma: Does the Patient Have a Cerebral Vascular Injury?

Blunt cerebrovascular injury involves injury to the carotid and/or vertebral arteries sustained via generalized multitrauma or directed blunt craniocervical trauma. Stroke remains the most consequential outcome. Timely diagnosis and initiation of treatment before the development of neurologic complications has a well-established role in decreasing morbidity and mortality. This article presents evidence and controversies surrounding the optimization of diagnostic imaging for suspected blunt cerebrovascular injury. Discussion centers on the increasing reliance on multidetector computed tomography angiography for screening, considering relevant clinical criteria for determining screening. Imaging protocols, imaging findings, injury grading, pearls, and pitfalls are discussed.