The online version of this article (doi:10.1186/1752-1947-8-344) contains supplementary material, which is available to authorized users.
The authors declare that they have no competing interests.
Both authors are the main health care providers for this patient. Both authors read and approved the final manuscript.
The frequency of vertebrobasilar ischemia in patients with cervical spine trauma had been regarded as low in many published papers. However, some case reports have described cervical spine injury associated with blunt vertebral artery injury. Many aspects of the management of vertebral artery injuries still remain controversial, including the screening criteria, the diagnostic modality, and the optimal treatment for various lesions. The case of a patient who had a brain infarction due to recanalization of his occluded vertebral artery following open reduction of cervical spinal dislocation is presented here.
A 41-year-old Asian man presented with C4 to C5 distractive flexion injury manifesting with quadriplegia and anesthesia below his C3 cord level (including phrenic nerve paralysis), and bowel and bladder dysfunction. Magnetic resonance angiography and computed tomography angiography showed left extracranial vertebral artery occlusion and patent contralateral vertebral artery. He was observed without antiplatelet and/or anticoagulation therapy, and underwent surgery (open reduction and internal fusion of C4 to C5, and tracheostomy) 8 hours after the injury. After surgery, supraspinal symptoms such as left horizontal nystagmus and left homonymous hemianopsia led to cranial computed tomography and magnetic resonance imaging, which showed left-side cerebellar infarction in his posterior inferior cerebellar artery territory and right-side posterior cerebral artery infarction. Magnetic resonance angiography and computed tomography angiography demonstrated patent bilateral vertebral artery (but hypoplastic right vertebral artery) and occluded right posterior cerebral artery. His injured vertebral artery was treated conservatively, which did not cause any other ischemic complications.
The management of asymptomatic vertebral artery injury is controversial with several treatment options available, including observation alone, antiplatelet therapy, anticoagulation therapy, or invasive intervention. Although there are some reports in which management with observation alone is described as safe, we should pay serious attention to the vertebral artery injury caused by cervical spine trauma.
Authors’ original file for figure 113256_2013_2967_MOESM1_ESM.tif
Authors’ original file for figure 213256_2013_2967_MOESM2_ESM.tif
Authors’ original file for figure 313256_2013_2967_MOESM3_ESM.tif
Authors’ original file for figure 413256_2013_2967_MOESM4_ESM.tif
Authors’ original file for figure 513256_2013_2967_MOESM5_ESM.tif
Yoshihara H, VanderHeiden TF, Harasaki Y, Beauchamp KM, Stahel PF: Fatal outcome after brain stem infarction related to bilateral artery occlusion – case report of a detrimental complication of cervical spine trauma. Patient Safe Surg. 2011, 5: 18-10.1186/1754-9493-5-18. CrossRef
Bula WI, Loes DJ: Trauma to the cerebrovascular system. Neuroimaging Clin North Am. 1994, 4: 753-772.
Louw JA, Mafoyane NA, Small B, Neser CP: Occlusion of the vertebral artery in cervical spine dislocations. J Bone Joint Surg Br. 1990, 72: 679-681. PubMed
Okuyama T, Minamida Y, Sasaki T, Horikawa D, Izumiyama O, Mizuguchi M, Shoji T, Kaneko M, Shinya T, Hashi K: Traumatic occlusion of the bilateral vertebral arteries associated with fracture of the cervical spine: a case report. Neurol Surg. 1987, 15: 1141-1145.
Tudorache C, Moldovanu A, Esanu A, Moldovanu E, Gherman C, Ichim C, Popescu C, Dabija M, Haba D: The posttraumatic occlusion of the vertebral artery case presentation. Rom Neurosurg. 2010, 17: 238-245.
Levy C, Laissy JP, Raveau V, Amarenco P, Servois V, Bousser MG, Tubiana JM: Carotid and vertebral artery dissections: three-dimensional time-of-flight MR angiography and MR imaging versus conventional angiography. Radiology. 1994, 190: 326-329. CrossRef
Bromberg WJ, Collier BC, Diebel LN, Dwyer KM, Holevar MR, Jacob DG, Kurek SJ, Schreiber MA, Shapiro ML, Vogel TR: Blunt cerebrovascular injury practice management guidelines: the Eastern Association for the Surgery of Trauma. J Trauma. 2010, 68: 471-477. PubMed
Cothren CC, Moore EE, Biffl WL, Ciesla DJ, Johnson JL, Moore JB, Burch JM: Anticoagulation is the gold standard therapy for blunt carotid injuries to reduce stroke rate. Arch Surg. 2004, 139: 609-613. 10.1001/archsurg.139.6.609. CrossRef
- Embolic brain infarction related to posttraumatic occlusion of vertebral artery resulting from cervical spine injury: a case report
- BioMed Central