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KMID : 1150320230190020078
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Journal of Korean Society of Geriatric Neurosurgery
2023 Volume.19 No. 2 p.78 ~ p.82
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Delayed cerebral infarction due to vertebral artery dissection following a cervical spine fracture: a case report
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Shin Jeong-Eun
Lee Jong-Young
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Abstract
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Traumatic vertebral artery dissection (VAD) following a cervical spinal injury is rare. Unilateral VAD does not usually cause neurologic symptoms, especially in the case of a non-dominant vertebral artery (VA), due to sufficient collateral blood supply. Nevertheless, doctors should be highly cautious of the possibility of new neurologic symptoms because dissection can cause symptomatic cerebral infarction after the latency period. An 80-year-old female patient visited the emergency room with posterior neck pain and dizziness that persisted since falling down the stairs. Immediately after the visit, a type 3 odontoid fracture including the C2 transverse foramen was identified, along with occlusion of the V2 segment of the left VA. No other abnormal findings were noted basilar top occlusion due to VAD occurred while planning cervical fixation surgery for the cervical fracture following the trauma without administering an anticoagulant. Mechanical thrombectomy was performed and internal trapping was performed for VAD. Subsequently, neurological symptoms showed improvement and the planned cervical fixation was subsequently performed. VAD must be suspected in some cervical fracture patients. Some reports have stated that administering intravenous heparin once VAD is identified may reduce the likelihood of a subsequent stroke; however, drug administration may inevitably be delayed in asymptomatic patients planning to receive additional surgery due to trauma. Cerebral infarction may occur due to a thrombus caused by the dissection at this time, but the cause may be eliminated with mechanical thrombectomy and internal trapping, which also obviates the necessity for continued antiplatelet administration.
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KEYWORD
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Vertebral artery dissection, Cerebral infarction, Cervical spine fracture, Internal trapping
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