Blunt cerebrovascular injury may be caused by a variety of injury mechanisms. Relatively minor injury mechanisms may produce significant injury. Examples include hyperflexion or extension injuries of the neck producing vertebral artery occlusion and subsequent embolization into the posterior cerebral circulation. For the purposes of screening large populations of trauma patients, potential for blunt cerebrovascular injury is most often associated with severe closed head injury, cervical spine fracture (especially if the vertebral foramina are affected), skull base fractures, severe midface fractures, and presence of a “seat-belt sign” across the base of the neck. Cranial nerve findings associated with blunt force trauma to the head or neck are also suggestive of proximity to carotid and vertebral arteries.