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Forensic Science, Medicine, and Pathology

, Volume 8, Issue 3, pp 334–337 | Cite as

Death due to extensive cervicomedullary infarction following iatrogenic vertebral artery occlusion

  • Marian Wang
Images in Forensics

Case report

Clinical history

An 85 year old female with a medical history of hypertension and hyperlipidemia was newly diagnosed with carcinoma of the right breast with metastasis to the spine, resulting in a pathological fracture at the level of the second cervical vertebra. She underwent operative stabilization of the cervical spine.

The operation was carried out under general anesthesia via the posterior approach. Occipital-cervical spine stabilization was established with the aid of an occipital plate, C1 lateral mass screws, C2 pars interarticularis screws, C3 lateral mass screws and C4 pedicle screws, with a connecting rod applied across the levels on each side. Immediately after the operation, the anesthetist observed the patient had prolonged apnea, depressed conscious level and a lack of gag reflex, despite cessation of all sedatives for more than an hour and the administration of intravenous naloxone. Her blood pressure started to drift downwards. She was conveyed to the...

Keywords

Vertebral Artery Pedicle Screw Cervical Vertebra Cervical Cord Thoracic Outlet Syndrome 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

References

  1. 1.
    Ernst E. Adverse effects of spinal manipulation: a systemic review. J R Soc Med. 2007;100:330–8.PubMedCrossRefGoogle Scholar
  2. 2.
    Ernst E. Deaths after chiropractic: a review of published cases. Int J Clin Pract. 2010;64:1162–5.PubMedCrossRefGoogle Scholar
  3. 3.
    Murphy DR. Current understanding of the relationship between cervical manipulation and stroke: what does it mean for the chiropractic profession? Chiropr Osteopat. 2010;18:22.PubMedCrossRefGoogle Scholar
  4. 4.
    Miley ML, Wellik KE, Wingerchuk DM, Demaerschalk BM. Does cervical manipulative therapy cause vertebral artery dissection and stroke? Neurologist. 2008;14:66–73.PubMedCrossRefGoogle Scholar
  5. 5.
    Inamasu J, Guiot BH. Iatrogenic vertebral artery injury. Acta Neurol Scand. 2005;112:349–57.PubMedCrossRefGoogle Scholar
  6. 6.
    Rozin L, Rozin R, Koehler SA, Shakir A, Ladham S, Barmada M, Dominick J, Wecht CH. Death during transforaminal epidural steroid nerve root block (C7) due to perforation of the left vertebral artery. Am J Forensic Med Pathol. 2003;24:351–5.PubMedCrossRefGoogle Scholar
  7. 7.
    Wright NM, Lauryssen C. Vertebral artery injury in C1–2 transarticular screw fixation: results of a survey of the AANS/CNS section on disorders of the spine and peripheral nerves. American Association of Neurological Surgeons/Congress of Neurological surgeons. J Neurosurg. 1998;88:634–40.PubMedCrossRefGoogle Scholar
  8. 8.
    Peng CW, Chou BT, Bendo JA, Spivak JM. Vertebral artery injury in cervical spine surgery: anatomical considerations, management, and preventive measures. Spine J. 2009;9:70–6.PubMedCrossRefGoogle Scholar
  9. 9.
    Neo M, Fujibayashi S, Miyata M, Takemoto M, Nakamura T. Vertebral artery injury during cervical spine surgery: a survey of more than 5600 operations. Spine. 2008;33:779–85.PubMedCrossRefGoogle Scholar
  10. 10.
    Peng CW, Chou BT, Bendo JA, Spivak JM. Vertebral artery injury in cervical spine surgery: anatomical considerations, management, and preventive measures. Spine J. 2009;9:70–6.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2012

Authors and Affiliations

  1. 1.Forensic Medicine DivisionHealth Sciences AuthoritySingaporeSingapore

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