Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States.
Department of Neurosurgery, San Jorge Children & Women's Hospital, Santurce, PR, United States.
Clin Neurol Neurosurg. 2022 Dec;223:107479. doi: 10.1016/j.clineuro.2022.107479. Epub 2022 Oct 21.
Traumatic brain injury is a complex and highly heterogeneous disease due to the host of concomitant injuries that may accompany the initial insult. Due to the dynamic interplay between the injuries that may arise, the management of these injuries is challenging. In a small subset of patients with traumatic brain injury, cerebral vascular injury may occur, which presents its own diagnostic and therapeutic challenges. These vascular injuries often present in a delayed fashion, thereby going unnoticed by clinicians. Early recognition and treatment of these injuries is crucial, given their high morbidity and mortality. Through a critical review of the literature, we present the spectrum of cerebrovascular injuries that may occur with traumatic brain injury and discuss classification systems that are used to stratify cerebrovascular injury. We then focus on the diagnosis of cerebral vascular injury using different neuroimaging modalities. Lastly, we explore the treatment of these injuries ranging from antiplatelet therapies to endovascular and open vascular procedures. By highlighting the pitfalls and challenges of this complex disease, we hope to provide clinicians with the framework to recognize and treat vascular injuries that are seen in patients with traumatic brain injury.
创伤性脑损伤是一种复杂且高度异质的疾病，因为可能伴随着初始损伤的伴随损伤很多。由于可能发生的损伤之间存在动态相互作用，因此这些损伤的管理具有挑战性。在一小部分创伤性脑损伤患者中，可能会发生脑血管损伤，这带来了自身的诊断和治疗挑战。这些血管损伤通常延迟出现，因此临床医生可能没有注意到。鉴于其高发病率和死亡率，早期识别和治疗这些损伤至关重要。通过对文献的批判性回顾，我们介绍了可能与创伤性脑损伤相关的脑血管损伤谱，并讨论了用于分层脑血管损伤的分类系统。然后，我们专注于使用不同的神经影像学方式来诊断脑血管损伤。最后，我们探讨了这些损伤的治疗方法，从抗血小板治疗到血管内和开放血管手术。通过突出这个复杂疾病的陷阱和挑战，我们希望为临床医生提供识别和治疗创伤性脑损伤患者中出现的血管损伤的框架。
