Blunt Cervical Vascular Injury

Cervical cerebrovascular injury occurs in approximately 1% of patients presenting with blunt trauma, but it carries a high morbidity (80%) and mortality (40%) when left undiagnosed. Cervical spine fractures, especially between C1 and C6, are at higher risk for injury to the cervical cerebrovasculature. These injuries are graded I–V in order of ascending severity. The diagnosis is established using a vascular imaging study, predominantly CT angiography. Once diagnosed, the treatment is predominantly medical with antiplatelet or anticoagulation therapy, and its presence should not preclude reduction of a fractured or subluxed vertebrae. The medical therapy should be continued for 3–6 months with regular follow-up vascular imaging to assess for progression of the injury. Overall, blunt cervical vascular injury should be suspected in patients with cervical spine fractures or trauma to the head and neck region, and it should be treated medically.