Journal of Korean Neurosurgical Society

The Korean Neurosurgical Society (대한신경외과학회)
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Delayed Brain Infarction due to Bilateral Vertebral Artery Occlusion Which Occurred 5 Days after Cervical Trauma

  • Jang, Donghwan (Department of Neurosurgery, Kangwon National University Hospital) ;
  • Kim, Choonghyo (Department of Neurosurgery, Kangwon National University Hospital) ;
  • Lee, Seung Jin (Department of Neurosurgery, Kangwon National University Hospital) ;
  • Kim, Jiha (Department of Neurosurgery, Kangwon National University Hospital)
  • Received : 2014.04.08
  • Accepted : 2014.08.16
  • Published : 2014.08.28
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Abstract

Vertebral artery (VA) injuries usually accompany cervical trauma. Although these injuries are commonly asymptomatic, some result in vertebrobasilar infarction. The symptoms of VA occlusion have been reported to usually manifest within 24 hours after trauma. The symptoms of bilateral VA occlusions seem to be more severe and seem to occur with shorter latencies than those of unilateral occlusions. A 48-year-old man had a C3-4 fracture-dislocation with spinal cord compression that resulted from a traffic accident. After surgery, his initial quadriparesis gradually improved. However, he complained of sudden headache and dizziness on the 5th postoperative day. His motor weakness was abruptly aggravated. Radiologic evaluation revealed an infarction in the occipital lobe and cerebellum. Cerebral angiography revealed complete bilateral VA occlusion. We administered anticoagulation therapy. After 6 months, his weakness had only partially improved. This case demonstrates that delayed infarction due to bilateral VA occlusion can occur at latencies as long as 5 days. Thus, we recommend that patients with cervical traumas that may be accompanied by bilateral VA occlusion should be closely observed for longer than 5 days.

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References

  1. Beletsky V, Nadareishvili Z, Lynch J, Shuaib A, Woolfenden A, Norris JW, et al. : Cervical arterial dissection : time for a therapeutic trial? Stroke 34 : 2856-2860, 2003 https://doi.org/10.1161/01.STR.0000098649.39767.BC
  2. Chung D, Sung JK, Cho DC, Kang DH : Vertebral artery injury in destabilized midcervical spine trauma; predisposing factors and proposed mechanism. Acta Neurochir (Wien) 154 : 2091-2098; discussion 2098, 2012 https://doi.org/10.1007/s00701-012-1499-6
  3. Deen HG Jr, McGirr SJ : Vertebral artery injury associated with cervical spine fracture. Report of two cases. Spine (Phila Pa 1976) 17 : 230-234, 1992 https://doi.org/10.1097/00007632-199202000-00019
  4. Desouza RM, Crocker MJ, Haliasos N, Rennie A, Saxena A : Blunt traumatic vertebral artery injury : a clinical review. Eur Spine J 20 : 1405-1416, 2011 https://doi.org/10.1007/s00586-011-1862-y
  5. Fink KR, Fink JR, Cohen WA : Cervical collaterals may protect against stroke after blunt vertebral artery injury. Emerg Radiol 18 : 545-549, 2011 https://doi.org/10.1007/s10140-011-0981-4
  6. Friedman D, Flanders A, Thomas C, Millar W : Vertebral artery injury after acute cervical spine trauma : rate of occurrence as detected by MR angiography and assessment of clinical consequences. AJR Am J Roentgenol 164 : 443-447; discussion 448-449, 1995 https://doi.org/10.2214/ajr.164.2.7839986
  7. Galtes I, Borondo JC, Cos M, Subirana M, Martin-Fumado C, Castella J, et al. : Traumatic bilateral vertebral artery dissection. Forensic Sci Int 214 : e12-e15, 2012 https://doi.org/10.1016/j.forsciint.2011.07.005
  8. Golueke P, Sclafani S, Phillips T, Goldstein A, Scalea T, Duncan A : Vertebral artery injury--diagnosis and management. J Trauma 27 : 856-865, 1987 https://doi.org/10.1097/00005373-198708000-00003
  9. Harrigan MR, Hadley MN, Dhall SS, Walters BC, Aarabi B, Gelb DE, et al. : Management of vertebral artery injuries following non-penetrating cervical trauma. Neurosurgery 72 Suppl 2 : 234-243, 2013 https://doi.org/10.1227/NEU.0b013e31827765f5
  10. Hart DJ : To screen or not to screen : vertebral artery injuries in blunt cervical spine trauma. World Neurosurg 80 : 309-310, 2013 https://doi.org/10.1016/j.wneu.2012.10.032
  11. Kim CH, Cho KT, Chung CK : Vertebral artery injury following blunt trauma to the cervical spine case report and literature review. J Korean Neurosurg Soc 35 : 625-627, 2004
  12. Lebl DR, Bono CM, Velmahos G, Metkar U, Nguyen J, Harris MB : Vertebral artery injury associated with blunt cervical spine trauma : a multivariate regression analysis. Spine (Phila Pa 1976) 38 : 1352-1361, 2013 https://doi.org/10.1097/BRS.0b013e318294bacb
  13. Medhkour A, Chan M : An unusually favorable outcome of bilateral vertebral arterial dissections : case report and review of the literature. J Trauma 58 : 1285-1289, 2005 https://doi.org/10.1097/01.TA.0000171370.92018.54
  14. Mimata Y, Murakami H, Sato K, Suzuki Y : Bilateral cerebellar and brain stem infarction resulting from vertebral artery injury following cervical trauma without radiographic damage of the spinal column : a case report. Skeletal Radiol 43 : 99-105, 2014 https://doi.org/10.1007/s00256-013-1722-4
  15. Mitha AP, Kalb S, Ribas-Nijkerk JC, Solano J, McDougall CG, Albuquerque FC, et al. : Clinical outcome after vertebral artery injury following blunt cervical spine trauma. World Neurosurg 80 : 399-404, 2013 https://doi.org/10.1016/j.wneu.2012.04.029
  16. Miyachi S, Okamura K, Watanabe M, Inoue N, Nagatani T, Takagi T : Cerebellar stroke due to vertebral artery occlusion after cervical spine trauma. Two case reports. Spine (Phila Pa 1976) 19 : 83-88, 1994 https://doi.org/10.1097/00007632-199401000-00019
  17. Mueller CA, Peters I, Podlogar M, Kovacs A, Urbach H, Schaller K, et al. : Vertebral artery injuries following cervical spine trauma : a prospective observational study. Eur Spine J 20 : 2202-2209, 2011 https://doi.org/10.1007/s00586-011-1887-2
  18. Muratsu H, Doita M, Yanagi T, Sekiguchi K, Nishida K, Tomioka M, et al. : Cerebellar infarction resulting from vertebral artery occlusion associated with a Jefferson fracture. J Spinal Disord Tech 18 : 293-296, 2005
  19. Parent AD, Harkey HL, Touchstone DA, Smith EE, Smith RR : Lateral cervical spine dislocation and vertebral artery injury. Neurosurgery 31 : 501-509, 1992 https://doi.org/10.1227/00006123-199209000-00012
  20. Schneck M, Simionescu M, Bijari A : Bilateral vertebral artery dissection possibly precipitated in delayed fashion as a result of roller coaster rides. J Stroke Cerebrovasc Dis 17 : 39-41, 2008 https://doi.org/10.1016/j.jstrokecerebrovasdis.2007.09.003
  21. Six EG, Stringer WL, Cowley AR, Davis CH Jr : Posttraumatic bilateral vertebral artery occlusion : case report. J Neurosurg 54 : 814-817, 1981 https://doi.org/10.3171/jns.1981.54.6.0814
  22. Taneichi H, Suda K, Kajino T, Kaneda K : Traumatically induced vertebral artery occlusion associated with cervical spine injuries : prospective study using magnetic resonance angiography. Spine (Phila Pa 1976) 30 : 1955-1962, 2005 https://doi.org/10.1097/01.brs.0000176186.64276.d4
  23. Woolsey RM, Chung HD : Fatal basilar artery occlusion following cervical spine injury. Paraplegia 17 : 280-283, 1979 https://doi.org/10.1038/sc.1979.55
  24. Yoshihara H, Vanderheiden TF, Harasaki Y, Beauchamp KM, Stahel PF : Fatal outcome after brain stem infarction related to bilateral vertebral artery occlusion - case report of a detrimental complication of cervical spine trauma. Patient Saf Surg 5 : 18, 2011 https://doi.org/10.1186/1754-9493-5-18

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