Acute ischemic stroke in a trauma cohort: Incidence and diagnostic challenges

Diagnosis of acute ischemic stroke is critical for acute intervention. Its diagnosis may be obscured in trauma patients due to confounding injuries. We report its incidence in trauma patients following their presentation at our institution.

Electronic charts of all acute trauma patients presenting to a designated level 1 trauma center emergency department between September 2012-November 2015 were screened and included in the study if they had a discharge diagnosis of acute ischemic stroke. Patient data were reviewed to identify the presence of neurologic deficit on initial triage, imaging type obtained (intracranial or extracranial) and time to diagnosis of stroke.

Of 192 trauma patients screened, 11 were found to have acute ischemic stroke (5.7%). Patients were generally young (median age, 49 years) and predominantly males (n = 8). Presentation after vehicular crash was most frequent (n = 8 or 73%). Patients had predominantly skeletal injuries (n = 8 or 73%). Initial workup involved vascular imaging below the neck (n = 9), while only one had intracranial vascular imaging. When patients underwent cervicocranial vascular imaging, 64% (n = 7) had findings explaining the etiology of their stroke. None of the patients was diagnosed with acute ischemic stroke on admission. Its diagnosis was delayed by an average 1.8 days following presentation.

Acute ischemic stroke in trauma patients was a frequent diagnosis albeit with delay. Routine craniocervical vascular imaging at the time of presentation could potentially facilitate early diagnosis. A prospective study with routine craniocervical vascular imaging in trauma patients will be needed to further explore this hypothesis.