You will be presented with the full text of a biomedical research paper. Please write an abstract for this paper. Your response should include the abstract and no additional text.

Paper text:
blunt cerebrovascular injury ( bcvi ) is caused by neck trauma that predominantly occurs in high - impact injuries including motor vehicle - related accidents , car - pedestrian collisions , falls , and skiing or snowmobile accidents .
however , a lucid interval occurs in many cases , and this may lead to a delayed diagnosis .
we experienced a case of cervical spinal fracture caused by a direct blunt external low - energy force .
initially , there was no disturbance of consciousness , but 6 hours later loss of consciousness occurred due to traumatic dissection of the carotid artery that resulted in cerebral infarction .
this case indicates that bcvi should be considered in a patient with blunt neck trauma , particularly when this is accompanied by a cervical spinal fracture .
a 52-year - old man who was working at a factory put his head into a big drum - type washing machine . the door closed suddenly and crushed his neck by sandwiching him between the machine and the door . upon transfer to our hospital , he was conscious with a glasgow coma scale ( gcs ) of e4v5m6 , and a subcutaneous hematoma was present on the right side of the neck ( fig .
the patient complained of neck pain and numbness in both hands , but there was no apparent limb paralysis .
a spinous process fracture at the c6 and c7 levels was detected in a cervical ct ( fig .
2a , b ) , and there was swelling of the right neck in the ct ( fig .
after fixation of a cervical collar , the patient was admitted to the intensive care unit .
subcutaneous hematoma ( arrow ) in the neck cervical ct showed a spinous process fracture ( arrow ) at the c6 ( a ) and c7 ( b ) levels .
swelling was present around the right neck in cervical ct ( circles ) cervical spondylotic changes observed in cervical spine mri t1 ( a ) and t2 ( b ) .
six hours after injury , paralysis suddenly developed in the left upper and lower extremities , and a decline in consciousness appeared with a gcs of e1v2m5 .
emergency head mri was performed after consultation with a neurosurgeon , and acute infarction of the right middle cerebral artery perfusion area was found ( fig .
mri angiography showed blockage of the right common carotid artery and internal carotid artery , and hypoperfusion of the middle cerebral artery ( fig .
this led to a diagnosis of right cerebral infarction due to acute vascular occlusion associated with right carotid artery dissection in the neck trauma .
edaravone and glycerol were administered to improve brain edema , and mechanical ventilation after tracheal intubation was performed on the same day . on the next day , extensive brain edema was observed in a head ct , and an emergency craniectomy and internal decompression were performed by a neurosurgeon ( fig .
7a , b ) . however , improvement in the brain edema was insufficient , and the patient died on day 7 .
the patient s wife and son gave informed consent for submission of this case study for publication .
acute infarction of the right middle cerebral artery based on perfusion of this area in head diffusion - weighted mri at six hours after injury .
( a ) disruption of the common carotid artery at six hours after injury ( arrow ) .
( b ) due to occlusion of the right internal carotid artery ( triangles ) and poor collateral circulation through the posterior communicating ( pcom ) artery and anterior communicating ( acom ) artery , the right middle cerebral artery was disrupted ( arrow ) at six hours after injury .
( a ) head ct on the day after injury showed a low - density area in the mca region and compression of the anterior horn of the lateral ventricle due to swelling , and the midline shift was more than 10 mm .
( b ) two days after injury , swelling was worse , and the low - density area had expanded on head ct after craniectomy and internal decompression .
bcvi may occur due to damage to the vertebral and carotid arteries , mainly by blunt neck trauma .
the frequency is between 0.50% and 1.55% of all cases of blunt trauma . among patients at high risk based on criteria , including an extensive skull base fracture , cervical fracture , cervical soft tissue hematoma , and facial fracture , the incidence of bcvi is much higher , in the range of 2444% . in 185 cases diagnosed with bcvi , bruns et al
. found that a motor vehicle collision ( 52% ) was the primary cause of injury , followed by a fall ( 20% ) and collisions involving a motor cycle ( 11% ) , a pedestrian ( 8% ) , and a cyclist ( 3% ) .
also suggested that bcvi could occur after a minor impact , such as cervical traction and heading a soccer ball ,   but there are few reports of this condition caused by blunt external force , as described in the present case . in a study of 17,007 admissions for blunt injury , cothren et al .
most fracture patterns were subluxations ( 56 patients ) , upper c1 to c3 body fractures ( 42 patients ) , and transverse foramen fractures ( 19 patients ) , whereas spinous process fractures of the lower cervical spine were rare ( 2 patients ) .
the denver screening criteria provide a screening protocol for bcvi diagnosis based on injury mechanisms , injury patterns , and symptoms ( table 1 ) .
this protocol can identify trauma patients at risk for bcvi with a sensitivity of 97% and a specificity of 42% . in our case , " expanding cervical hematoma " and " cervical spinal fracture " were consistent with the denver screening criteria , but bcvi was not initially suspected and the patient was not diagnosed with bcvi until after loss of consciousness .
ultrasonography , ct angiography , and magnetic resonance angiography ( mra ) are effective noninvasive diagnostic modalities for screening and evaluation of soft tissue in the initial treatment of blunt trauma .
ultrasonography is particularly useful for diagnosis of macrovascular damage and airway narrowing , and is desirable as a secondary examination .
ultrasonography , mri , and mra are all relatively easy to use as screening tools .
the pathogenesis of cerebral infarction after vascular injury involves acute occlusion of the major artery by dissection , and embolization by the thrombus around the dissection . in our patient ,
since there were no infarctions in the pca and aca areas , embolization would have occurred at the base of the mca with the common carotid artery dissection .
the main symptom of traumatic carotid artery occlusion is loss of consciousness that occurs after a lucid interval .
neurological deficits , such as aphasia and hemiplegia , and transient ischemic attack may also occur .
found that a lucid interval occurred in 74% of the cases and that the incidence within 24 hours after injury was 77.4% . in our case ,
initially , consciousness was normal and we did not perform a head mri or mra . in previous reports ,
onset of cerebral infarction occurred within 24 hours of injury in 80% of the cases .
the prognosis is very poor , with a mortality of traumatic carotid artery occlusion of 38.5% , and serious sequelae occur in 50% of the cases . in this case , we experienced a patient with a cerebral infarction caused by a combination of a lower cervical spinal fracture and traumatic injury to the carotid artery .
since there was no loss of consciousness in the acute phase , we missed the bcvi diagnosis that led to the cerebral infarction in the middle cerebral artery lesion resulting in loss of consciousness after 6 hours .
an emergency craniectomy and internal decompression were performed by a neurosurgeon , but unfortunately this did not provide a sufficient decompression effect and was unsuccessful .
( 1 ) in spite of the cervical hematoma , we did not perform a doppler us or an early ct angiography as a screening test .
( 2 ) although the initial level of consciousness corresponded to a lucid interval , we should have paid closer attention to the possibility of a loss of consciousness .
( 3 ) although there was a major blunt trauma to the neck , a hematoma , and a cervical fracture , we did not suspect bvci initially .
we should have considered the injury mechanism , injury pattern , and symptoms of cvi in the denver screening criteria as described above ( table1 ) .
bcvi leads to a high incidence of cerebral infarction , with 41% and 16% observed respectively in injuries to the carotid and vertebral arteries .
this case demonstrates that cervical vascular injury should be considered in a patient with blunt neck trauma and that additional imaging ( doppler us , ct angiography , mra if possibly ) should be performed .
in addition , if bcvi were identified early , then antithrombotic treatment heparin ( ptt 4050 sec ) or antiplatelet therapy would be desirable . if the injury is surgically accessible depending on the degree of damage , bypass surgery and endovascular treatment with a stent should be performed .
we predict that if immediate action and aggressive measures were taken , it might have prevented a fatal outcome .
none of the authors have a conflict of interest regarding the contents of the manuscript .
abstractblunt cerebrovascular injury ( bcvi ) is usually caused by neck trauma that predominantly occurs in high - impact injuries . 
 bcvi may occur due to damage to both the vertebral and carotid arteries , and may be fatal in the absence of appropriate treatment and early diagnosis . here 
 , we describe a case of cerebral infarction caused by a combination of a lower cervical spinal fracture and traumatic injury to the carotid artery by a direct blunt external force in a 52-year - old man . 
 initially , there was no effect on consciousness , but 6 hours later loss of consciousness occurred due to traumatic dissection of the carotid artery that resulted in a cerebral infarction . 
 brain edema was so extensive that decompression by emergency craniectomy and internal decompression were performed by a neurosurgeon , but with no effect , and the patient died on day 7 . 
 this is a rare case of cerebral infarction caused by a combination of a lower cervical spinal fracture and traumatic injury to the carotid artery . 
 the case suggests that cervical vascular injury should be considered in a patient with a blunt neck trauma and that additional imaging should be performed .