Uebelacker Morgan C, Rago Avram, Fahmy Joseph, Farish Alexandria
Emergency Medicine, University of South Florida Morsani College of Medicine, Tampa, USA.
Pediatrics, University of South Florida Morsani College of Medicine, Tampa, USA.
Cureus. 2025 Jun 30;17(6):e87067. doi: 10.7759/cureus.87067. eCollection 2025 Jun.
Blunt cerebrovascular injuries (BCVIs) are rare but potentially severe complications of blunt trauma and can lead to acute ischemic stroke. Diagnosis requires imaging but necessitates more cautious consideration in pediatrics due to radiation concerns. Management options span observation, anticoagulation, and various endovascular interventions, but decisions are complicated by limited literature and the presence of other traumatic injuries. Further collaborative research is needed to provide clarity when caring for pediatric patients with BCVI to guide diagnosis and management. A four-year-old male with no significant past medical history presented to the emergency department as a trauma activation secondary to injuries sustained after falling from a moving "swamp buggy" recreational vehicle. He was found to have severe craniofacial and cervical spine injuries including open bilateral mandibular fractures, C2-C3 distraction injury with associated spinal cord injury, and blunt left common carotid injury subsequently complicated by a left hemispheric stroke with right hemiplegia. Management challenges arose due to the complexity of injuries, with decisions regarding management of initial injuries and subsequent stroke treatment being particularly intricate. The patient underwent various interventions, including closed reduction of spinal fractures, halo vest placement, mandibular fracture repair and ultimately open internal fixation of spinal fractures via spinal fusion. Despite the severity of injuries, the patient had a positive outcome, underscoring the importance of multidisciplinary collaboration in trauma care. This is an uncommon injury presentation in a pediatric patient and this case was highlighted to demonstrate the diagnostic and treatment challenges regarding blunt cerebrovascular injuries in pediatric patients. Further research is needed to guide physicians caring for pediatric patients with blunt cerebrovascular injuries and the sequela of such injuries.
钝性脑血管损伤（BCVIs）虽罕见，但却是钝性创伤潜在的严重并发症，可导致急性缺血性中风。诊断需要影像学检查，但由于辐射问题，在儿科需要更谨慎地考虑。治疗选择包括观察、抗凝和各种血管内介入治疗，但由于文献有限以及存在其他创伤性损伤，决策变得复杂。需要进一步的合作研究，以明确如何护理患有BCVI的儿科患者，从而指导诊断和治疗。一名4岁男性，既往无重大病史，因从一辆正在行驶的“沼泽越野车”休闲车上跌落受伤后被激活创伤急救程序送至急诊科。他被发现有严重的颅面和颈椎损伤，包括双侧开放性下颌骨骨折、C2 - C3脱位伤伴相关脊髓损伤，以及钝性左侧颈总动脉损伤，随后并发左半球中风伴右侧偏瘫。由于损伤的复杂性，出现了治疗挑战，关于初始损伤的处理和随后中风治疗的决策尤其复杂。患者接受了各种干预措施，包括闭合复位脊柱骨折、佩戴头环背心、修复下颌骨骨折，最终通过脊柱融合术对脊柱骨折进行切开内固定。尽管损伤严重，但患者预后良好，强调了多学科协作在创伤护理中的重要性。这是儿科患者中一种罕见的损伤表现，突出该病例是为了展示儿科患者钝性脑血管损伤的诊断和治疗挑战。需要进一步研究以指导护理患有钝性脑血管损伤及其后遗症的儿科患者的医生。
