Advertisement

European Spine Journal

, Volume 27, Supplement 3, pp 510–514 | Cite as

Resolution of traumatic bilateral vertebral artery injury

  • Yutaka Igarashi
  • Takahiro Kanaya
  • Shoji Yokobori
  • Takeshi Tsukamoto
  • Hiroyuki Yokota
Case Report

Abstract

Purpose

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.

Case description

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.

Keywords

Spinal cord injury Blunt cerebrovascular injury Vertebral artery injury Vertebral artery occlusion 

Notes

Acknowledgements

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.

References

  1. 1.
    Berne JD, Norwood SH, McAuley CE, Villareal DH (2004) Helical computed tomographic angiography: an excellent screening test for blunt cerebrovascular injury. J Trauma 57:11–17 (discussion 17–19) CrossRefPubMedGoogle Scholar
  2. 2.
    Cothren CC, Moore EE, Biffl WL, Ciesla DJ, Ray CE, Johnson JL, Moore JB, Burch JM (2003) Cervical spine fracture patterns predictive of blunt vertebral artery injury. J Trauma 55:811–813.  https://doi.org/10.1097/01.TA.0000092700.92587.32 CrossRefPubMedGoogle Scholar
  3. 3.
    Miller PR, Fabian TC, Croce MA, Cagiannos C, Williams JS, Vang M, Qaisi WG, Felker RE, Timmons SD (2002) Prospective screening for blunt cerebrovascular injuries: analysis of diagnostic modalities and outcomes. Ann Surg 236:386–393.  https://doi.org/10.1097/01.sla.0000027174.01008.a0 (discussion 385–393) CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    Lebl DR, Bono CM, Velmahos G, Metkar U, Nguyen J, Harris MB (2013) Vertebral artery injury associated with blunt cervical spine trauma: a multivariate regression analysis. Spine (Phila Pa 1976) 38:1352–1361.  https://doi.org/10.1097/brs.0b013e318294bacb CrossRefGoogle Scholar
  5. 5.
    Torina PJ, Flanders AE, Carrino JA, Burns AS, Friedman DP, Harrop JS, Vacarro AR (2005) Incidence of vertebral artery thrombosis in cervical spine trauma: correlation with severity of spinal cord injury. AJNR Am J Neuroradiol 26:2645–2651PubMedGoogle Scholar
  6. 6.
    Biffl WL, Moore EE, Elliott JP, Ray C, Offner PJ, Franciose RJ, Brega KE, Burch JM (2000) The devastating potential of blunt vertebral arterial injuries. Ann Surg 231:672–681CrossRefPubMedPubMedCentralGoogle Scholar
  7. 7.
    Desouza RM, Crocker MJ, Haliasos N, Rennie A, Saxena A (2011) Blunt traumatic vertebral artery injury: a clinical review. Eur Spine J 20:1405–1416.  https://doi.org/10.1007/s00586-011-1862-y CrossRefPubMedPubMedCentralGoogle Scholar
  8. 8.
    Mueller CA, Peters I, Podlogar M, Kovacs A, Urbach H, Schaller K, Schramm J, Kral T (2011) Vertebral artery injuries following cervical spine trauma: a prospective observational study. Eur Spine J 20:2202–2209.  https://doi.org/10.1007/s00586-011-1887-2 CrossRefPubMedPubMedCentralGoogle Scholar
  9. 9.
    Biffl WL, Cothren CC, Moore EE, Kozar R, Cocanour C, Davis JW, McIntyre RC, West MA, Moore FA (2009) Western Trauma Association critical decisions in trauma: screening for and treatment of blunt cerebrovascular injuries. J Trauma 67:1150–1153.  https://doi.org/10.1097/TA.0b013e3181c1c1d6 CrossRefPubMedGoogle Scholar
  10. 10.
    Biffl WL, Moore EE, Offner PJ, Brega KE, Franciose RJ, Burch JM (1999) Blunt carotid arterial injuries: implications of a new grading scale. J Trauma 47:845–853CrossRefPubMedGoogle Scholar
  11. 11.
    Cothren CC, Biffl WL, Moore EE, Kashuk JL, Johnson JL (2009) Treatment for blunt cerebrovascular injuries: equivalence of anticoagulation and antiplatelet agents. Arch Surg 144:685–690.  https://doi.org/10.1001/archsurg.2009.111 CrossRefPubMedGoogle Scholar
  12. 12.
    Fabian TC, Patton JH, Croce MA, Minard G, Kudsk KA, Pritchard FE (1996) Blunt carotid injury. Importance of early diagnosis and anticoagulant therapy. Ann Surg 223:513–522 (discussion 515–522) CrossRefPubMedPubMedCentralGoogle Scholar
  13. 13.
    Biffl WL, Ray CE, Moore EE, Franciose RJ, Aly S, Heyrosa MG, Johnson JL, Burch JM (2002) Treatment-related outcomes from blunt cerebrovascular injuries: importance of routine follow-up arteriography. Ann Surg 235:699–706 (discussion 697–706) CrossRefPubMedPubMedCentralGoogle Scholar
  14. 14.
    Cothren CC, Moore EE, Biffl WL, Ciesla DJ, Ray CE, Johnson JL, Moore JB, Burch JM (2004) Anticoagulation is the gold standard therapy for blunt carotid injuries to reduce stroke rate. Arch Surg 139:540–545.  https://doi.org/10.1001/archsurg.139.5.540 (discussion 545–546) CrossRefPubMedGoogle Scholar
  15. 15.
    Cothren CC, Moore EE, Ray CE, Ciesla DJ, Johnson JL, Moore JB, Burch JM (2005) Screening for blunt cerebrovascular injuries is cost-effective. Am J Surg 190:845–849.  https://doi.org/10.1016/j.amjsurg.2005.08.007 PubMedGoogle Scholar
  16. 16.
    Miller PR, Fabian TC, Bee TK, Timmons S, Chamsuddin A, Finkle R, Croce MA (2001) Blunt cerebrovascular injuries: diagnosis and treatment. J Trauma 51:279–285 (discussion 276–285) CrossRefPubMedGoogle Scholar
  17. 17.
    Herrera DA, Vargas SA, Dublin AB (2008) Endovascular treatment of traumatic injuries of the vertebral artery. AJNR Am J Neuroradiol 29:1585–1589.  https://doi.org/10.3174/ajnr.A1123 CrossRefPubMedGoogle Scholar
  18. 18.
    Biffl WL, Moore EE (2011) Computed tomographic angiography for blunt cerebrovascular injuries: don’t throw out the baby with the bathwater. Ann Surg 253:451–452.  https://doi.org/10.1097/SLA.0b013e31820d990a CrossRefPubMedGoogle Scholar
  19. 19.
    Scott WW, Sharp S, Figueroa SA, Eastman AL, Hatchette CV, Madden CJ, Rickert KL (2015) Clinical and radiological outcomes following traumatic grade 3 and 4 vertebral artery injuries: a 10-year retrospective analysis from a level I trauma center. The Parkland Carotid and Vertebral Artery Injury Survey. J Neurosurg 122:1202–1207.  https://doi.org/10.3171/2014.9.JNS1461 CrossRefPubMedGoogle Scholar
  20. 20.
    Morton RP, Hanak BW, Levitt MR, Fink KR, Peterson EC, Vilela MD, Kim LJ, Chesnut RM (2014) Blunt traumatic occlusion of the internal carotid and vertebral arteries. J Neurosurg 120:1446–1450.  https://doi.org/10.3171/2014.2.JNS131658 CrossRefPubMedGoogle Scholar
  21. 21.
    Burlew CC, Biffl WL, Moore EE, Pieracci FM, Beauchamp KM, Stovall R, Wagenaar AE, Jurkovich GJ (2014) Endovascular stenting is rarely necessary for the management of blunt cerebrovascular injuries. J Am Coll Surg 218:1012–1017.  https://doi.org/10.1016/j.jamcollsurg.2014.01.042 CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • Yutaka Igarashi
    • 1
  • Takahiro Kanaya
    • 1
  • Shoji Yokobori
    • 1
  • Takeshi Tsukamoto
    • 1
  • Hiroyuki Yokota
    • 1
  1. 1.Department of Emergency and Critical Care MedicineNippon Medical SchoolTokyoJapan

Personalised recommendations