Hexachlorobenzene exposure: widespread toxicant produces pervasive effects.

Neurotrauma represents a significant public health problem, accounting for a significant proportion of the morbidity and mortality associated with all traumatic injuries. Both blunt and penetrating injuries to cervicocerebral vessels are significant and are likely more common than previously recognized. Imaging of such injuries is an important component in the evaluation of individuals presenting with such potential injuries, made all the more important since many of the vascular injuries are clinically silent. Management of injuries, particularly those caused by blunt trauma, is constantly evolving. This article addresses the current state of imaging and treatment of such injuries. Background Trauma is the third leading cause of death in all age groups [1], and accounts for more deaths in children and young adults than any other etiology. In the United States, there are approximately 150,000 trauma-related deaths annually with 80% of these deaths occurring in the teenage population [2]. Trauma is also the major cause of death in men under the age of 35 years; more than 70% of these mortalities are directly related to neurotrauma [3]. Neurotrauma carries the greatest impact regarding death and functional impairment compared to all other types of trauma. In a study of deaths in road traffic fatalities, 79% of motor vehicle induced fatalities involved head injuries [4]. In an epidemiological study performed in Southern Australia, cranio-cerebral and spinal cord injuries were the leading cause of death in those up to age 49 years. With 71% of deaths in this study due to neurotrauma, it is evident that severe trauma to the head and neck account for disproportionate mortality, especially as it pertains to the disruption of the underlying neurovasculature [5,6]. Neurovascular trauma can be organized into two major categories by its mechanism: blunt and penetrating trauma. Each accounts for significant morbidity and mortality. One retrospective evaluation concluded that the morbidity and mortality were greater in those patients with penetrating carotid injuries than with blunt injuries, but that this was true only in those patients with multilevel penetrating injuries [7]. In addition, Landreneau et al. found that patients with penetrating injuries involving both the carotid and vertebral arteries were subject to 50% Published: 9 January 2007 World Journal of Emergency Surgery 2007, 2:1 doi:10.1186/1749-7922-2-1 Received: 2 November 2006 Accepted: 9 January 2007 This article is available from: http://www.wjes.org/content/2/1/1 © 2007 Ray et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.