REHABILITATION OF MODERATE TO SEVERE TBI: NEUROLOGICAL DISORDERS: INTRACRANIAL COMPLICATIONS: VASCULAR COMPLICATIONS  

  1. Traumatic Aneurysm
    • Types:
      • True aneurysms, in which at least the adventitial wall is preserved
      • False aneurysms, the most common, in which all elements of the vascular wall are disrupted
      • Mixed, which have a combination of true and false aneurysms
      • Delayed, onset weeks after injury, are very rare (O'Brien, et al 1997)
    • Signs:
      • Delayed subarachnoid or intracerebral hemorrhage; SAH occurs frequently in TBI and can be difficult to detect and grade (Mattioli, et al 2003)
      • Slow to fill and empty on angiography
      • Prone to rupture, usually within 3 weeks postinjury
    • Causes: bony fragments, missile injuries, or acceleration-deceleration injuries
    • Sites: commonly in the distal middle cerebral branches, anterior cerebral artery, and proximal carotid and vertebral arteries
    • Treatment:
      • Surgery, including direct repair and revascularization when the parent vessel is sacrificed
      • Antiplatelet or anticoagulation therapy

  2. Traumatic Carotid Cavernous Fistula
    • Characterized by fast flow and high pressure
    • Occur usually > 1 month postinjury
    • Signs include supraorbital bruit, exophthalmus, orbital congestion, oculomotor palsies, trigeminal nerve involvement, and visual impairment
    • Treatment involves the endovascular placement of detachable balloons, although some patients have had success with intermittent manual compression of the cervical carotid artery

Based on information in Medical Rehabilitation of Traumatic Brain Injury, L.J. Horn and N.D. Zasler, eds. St. Louis, MO, Mosby, 1996, except for information where other papers are cited.