Resolution of traumatic bilateral vertebral artery injury
Cerebrovascular ischaemia is a rare but serious complication of damage to the carotid or vertebral arteries in the neck caused by blunt injury to the neck. Screening for blunt cerebrovascular injury should be performed in patients with certain signs or symptoms and risk factors. We described a case of traumatic bilateral vertebral artery injury (VAI) including unilateral vertebral arterial occlusion that resolved 3 months post-injury with antiplatelet and direct oral anticoagulant therapy. This resolution of traumatic bilateral VAI is very rare. Vertebral artery injury should be suspected in patients with displaced fracture dislocation of the cervical spine, particularly in the elder and those with ankylosing spondylitis, and therefore imaging of these patients should include a modality to look at the patency of the vertebral arteries.
A 70-year-old man who was diagnosed with ankylosing spondylitis collapsed and presented with tetraplegia. Computed tomography showed C3 fracture dislocation, and magnetic resonance imaging showed a high-signal intensity and intense compression of the spinal cord from C2 to C3. Cerebral angiogram showed left vertebral artery occlusion and right vertebral artery stenosis. Heparin was administered to prevent posterior circulation stroke and he underwent posterior fixation. Three months post-injury, a cerebral angiogram showed the resolution of the bilateral VAI.
KeywordsSpinal cord injury Blunt cerebrovascular injury Vertebral artery injury Vertebral artery occlusion
We would like to thank Dr. Yoshito Ishiki, his colleagues and nursing staffs for patient treatment: Dr. Hidetaka Onda, Dr. Kazuki Hagiwara, Dr. Kenta Shigeta, Dr. Junko Kobayashi, Dr. Kazuma Sasaki, and Dr. Hiroyuki Enomoto.
Compliance with ethical standards
Conflict of interest
There no conflicts of interests.
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