Approach to blunt cerebrovascular injury Quiz: Ace Your Exams
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A 37-year-old man is brought to the emergency department for evaluation after a fall that occurred while snowboarding. The patient was traveling at high speed without a helmet when he hit a rock. A cervical collar was placed before arrival. The patient has no significant past medical history, and he does not take any medication. Temperature is 37.0 °C (98.6 °F), pulse is 114/min, respirations are 22/min, blood pressure is 166/84 mmHg, and oxygen saturation is 98% on room air. Upon primary survey, the patient is slurring his words but can report neck pain. Bilateral breath sounds are auscultated on pulmonary exam. There are 2+ pulses in the upper and lower extremities bilaterally. Glasgow coma score (GCS) is 15, and vertical nystagmus is noted in the pupils bilaterally. Intravenous access is established. On secondary survey, bruising and swelling are noted on the anterior face. There is reproducible tenderness to palpation of the cervical spine. Computed tomography angiography (CTA) imaging of the head and neck shows a left vertebral artery dissection. Which of the following best describes this blunt cerebrovascular injury (BCVI) pattern?
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