Modified Memphis criteria for blunt cerebrovascular injury
The modified Memphis criteria are a set of screening criteria for blunt cerebrovascular injury (BCVI) in trauma. The presence of one or more of these criteria makes necessary a complementary CTA or DSA study to exclude a BCVI.
The screening protocol criteria for BCVI are:
- base of skull fracture with involvement of the carotid canal
- base of skull fracture with involvement of petrous temporal bone
- cervical spine fracture
- neurological exam findings not explained by neuroimaging
- Horner syndrome
- Le Fort II or III fracture pattern
- neck soft tissue injury (e.g. seatbelt sign, hanging, hematoma)
Ciapetti et al. showed that a modification of the original Memphis criteria could increase the sensitivity of BCVI 1. If a trauma patient meets one or many of these criteria, the diagnosis of BCVI should be excluded with CTA or DSA. DSA is far more sensitive than 32-MDCT 2 but less available. However, a study retrospectively applying the criteria has recently concluded that CTA should be performed on all multi-trauma patients for 37.5% of injuries would have been missed 3.
- Denver criteria of BCVI
- 1. Ciapetti M, Circelli A, Zagli G et-al. Diagnosis of carotid arterial injury in major trauma using a modification of Memphis criteria. Scand J Trauma Resusc Emerg Med. 2010;18 (1): 61. doi:10.1186/1757-7241-18-61 - Free text at pubmed - Pubmed citation
- 2. DiCocco JM, Emmett KP, Fabian TC et-al. Blunt cerebrovascular injury screening with 32-channel multidetector computed tomography: more slices still don't cut it. Ann. Surg. 2011;253 (3): 444-50. doi:10.1097/SLA.0b013e31820d946b - Pubmed citation
- 3. Bonatti M, Vezzali N, Ferro F et-al. Blunt cerebrovascular injury: diagnosis at whole-body MDCT for multi-trauma. Insights Imaging. 2013;4 (3): 347-55. doi:10.1007/s13244-013-0235-y - Free text at pubmed - Pubmed citation