Pitfalls in the angiographic diagnosis of serious head injury

The problems in interpretation of emergency cerebral arteriograms are discussed with relation to the apparent displacement of "landmark" vessels that is actually produced by rotation or by the type of anteroposterior projection of the vessels, rather than by mass lesions. Anterior cerebral artery, middle meningeal artery, and pineal displacements are reviewed, along with possible pitfalls of diagnosis and attempts at correction. Utilization of dried skulls afforded depth visualization of middle meningeal artery grooves as well as the radiographic projection. The most reliable region on each different type of anteroposterior projection is discussed with regard to the emergency situation where repeat angiographic detections or special views may not be possible.