Penetrating Stab Wounds to the Brain
- 1 November 1992
- journal article
- Published by Ovid Technologies (Wolters Kluwer Health) in Neurosurgery
- Vol. 31 (5), 905-912
- https://doi.org/10.1227/00006123-199211000-00012
Abstract
ANGIOGRAPHY IS ALWAYS necessary in patients with penetrating stab wounds to the head, to exclude unexpected vascular lesions. The most important, since they are seldom clinically evident, are traumatic aneurysms and arteriovenous fistulae. It has previously been proposed that carotid angiography should be delayed until the start of the second week, to allow for better visualization of these complications. However, traumatic aneurysms can rupture at any time after the injury, and the mortality resulting from a second hemorrhage is unacceptably high. A prospective study was undertaken in which 330 patients with penetrating stab wounds to the head underwent angiography as soon as possible after admission. In 250 of these patients (76%), the weapon had already been removed by the assailant, and there was radiological evidence of penetration of the dura. Of these 250, 130 patients underwent angiography within 7 days of the injury. Another 51 patients, who presented late, underwent angiography more than 7 days after the injury. The timing of angiography did not affect the identification of traumatic aneurysms, the incidence of which was 12% in both groups. Of the patients with cranial stabs and who required urgent evacuation of intracerebral hematomas, 10% had traumatic aneurysms that could be dealt with simultaneously. No patient in this series suffered a secondary hemorrhage. We conclude that it is neither necessary nor safe to delay angiography. In some patients, either because of vasospasm or “cut-off” of a vessel, a second angiogram may be necessary to further elucidate a vascular abnormality that might not have been evident originally.Keywords
This publication has 26 references indexed in Scilit:
- Traumatic Aneurysms of Brain Due to High Velocity Missile Head WoundsNeurosurgery, 1988
- Stab Wounds at the Craniocervical JunctionNeurosurgery, 1985
- Acute carotid-cavernous fistula with retained knife blade after transorbital stab woundSurgical Neurology, 1985
- Orbitofacial Wounds and Cerebral Artery Injuries Caused by Umbrella TipsPublished by American Medical Association (AMA) ,1978
- Traumatic aneurysm of peripheral cerebral arteriesJournal of Neurosurgery, 1977
- Intracranial complications of transorbital stab wounds.British Journal of Ophthalmology, 1975
- Traumatic cerebral aneurysms: Clinical features and natural historyJournal of Neurology, Neurosurgery & Psychiatry, 1973
- Traumatic aneurysms of the cerebral vesselsJournal of Neurosurgery, 1972
- Traumatic Aneurysm of a Peripheral Cerebral ArteryJournal of Neurosurgery, 1968
- Traumatic Aneurysm of the Anterior Choroidal ArteryJournal of Neurosurgery, 1966