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Blunt cerebrovascular injuries (BCVI) are a rare but potentially devastating injury with stroke rates up to 50%. Over the past decade, the recognition and subsequent management of these injuries has undergone a marked evolution. This review will focus on the rationale for BCVI screening, imaging options, and treatment modalities.There are no prospective randomized controlled trials evaluating the management of BCVI. Available studies support screening a high-risk patient population based upon injury mechanism and constellation of associated injuries using multidetector-row (16-slice or greater) computed tomographic angiography (CTA). Although the ideal regimen of antithrombotic therapy has yet to be determined, treatment with either anticoagulation or antiplatelet agents has been shown to reduce BCVI-related stroke rate.Cerebrovascular injuries (CVI) are now diagnosed in approximately 1% of blunt trauma patients. The recognition of a clinically silent period allows for injury screening based upon mechanism of trauma and the patient's injury pattern. Following identification of injuries in asymptomatic patients, prompt initiation of antithrombotic therapy reduces the incidence of stroke.