An analysis of the diagnostic yield of angiography for head and neck trauma showed that this safe method should be offered to any patient with a deteriorated neurological state, even if comatose. Indications were cases of suspected chronic subdural hematoma, progressive neurologic signs after head injury, and neck trauma with neurological deficits. Contraindications included infants, patients in shock, and those with rapidly clearing sensorium. Angiography permitted a more adequate surgical approach to traumatic lesions and reduced the incidence of negative trephinations. Angiography provides the best method of diagnosing and localizing interhemispheric and intracerebral hematomas associated with subdural hematomas, traumatic arteriovenous fistulas, and vascular trauma in the neck. The use of low carotid, brachial, or subclavian injection of contrast medium has demonstrated angiographically specific lesions of the neck vasculature.
Campbell JA, Campbell RL. Angiographic Diagnosis of Traumatic Head and Neck Lesions. JAMA. 1961;175(9):761-768. doi:10.1001/jama.1961.03040090021004