Neuro-trauma Award funded by Robert W Harvey, Allen & Patricia Ellen Coulson Estate
Neck artery trauma and microclots to the brain.
Associate Professor Richard Gerraty
Alfred Hospital, Monash University
Co-Investigators: Dr Anoop Madan, Dr Helen Kavnoudias and Mr Philip M Lewis
Head trauma may cause damage to the neck arteries, an injury called dissection. Clots breaking free of the dissected arterial lining may cause stroke, usually some days after the head injury. These dissections are frequently detected in the emergency department by computed tomography angiography (CTA), now a routine protocol in certain trauma patients. Intravenous anticoagulation is standard treatment for traumatic dissection, but is unproven and has not been shown to be superior to aspirin. Furthermore, heparin cannot be given safely in up to 50% of trauma patients. Transcranial Doppler ultrasound (TCD), an ultrasound test of the brain arteries, can detect tiny clots (microemboli) coming from dissected neck arteries. These can be recorded by computer and reliably counted electronically. By correlating microemboli counts with the grade of arterial injury as detected by CTA, and also the severity of the neurological injury, the patency of the intracranial arteries and the different treatments, heparin, aspirin or no treatment, the risk profile of different types of injury can be compiled. A low risk group may be identified who could be treated with aspirin or no therapy. For a sub-group potentially at high risk of stroke, this research will also be essential in planning a randomised trial of therapy, with the hope that serious stroke could be prevented in survivors of traumatic head injury who might otherwise make a good neurological recovery.