J Korean Med Sci.  2008 Aug;23(4):747-751. 10.3346/jkms.2008.23.4.747.

Traumatic Entrapment of the Vertebrobasilar Junction Due to a Longitudinal Clival Fracture: A Case Report

• Cho J
• Moon CT
• Kang HS
• Choe WJ
• Chang SK
• Koh YC
• Roh HG

• KMID: 1785844
• DOI: http://doi.org/10.3346/jkms.2008.23.4.747

Abstract

Vertebrobasilar junction entrapment due to a clivus fracture is a rare clinical observation. The present case report describes a 54-yr-old man who sustained a major craniofacial injury. The patient displayed a stuporous mental state (Glasgow Coma Scale [GCS]=8) and left hemiparesis (Grade 3). The initial computed tomography (CT) scan revealed a right subdural hemorrhage in the frontotemporal region, with a midline shift and longitudinal clival fracture. A decompressive craniectomy with removal of the hematoma was performed. Two days after surgery, a follow-up CT scan showed cerebellar and brain stem infarction, and a CT angiogram revealed occlusion of the left vertebral artery and entrapment of vertebrobasilar junction by the clival fracture. A decompressive suboccipital craniectomy was performed and the patient gradually recovered. This appears to be a rare case of traumatic vertebrobasilar junction entrapment due to a longitudinal clival fracture, including a cerebellar infarction caused by a left vertebral artery occlusion. A literature review is provided.

Keyword

Cranial Fossa, Posterior; Skull Fracture, Basilar; Vertebral artery; Brain Infarction

MeSH Terms

Basilar Artery/*injuries
Humans
Male
Middle Aged
Skull Fractures/*complications/radiography
Tomography, X-Ray Computed
Vertebral Artery/*injuries