J Korean Neurosurg Soc.  2014 Aug;56(2):141-145. 10.3340/jkns.2014.56.2.141.

Delayed Brain Infarction due to Bilateral Vertebral Artery Occlusion Which Occurred 5 Days after Cervical Trauma

• Jang D
• Kim C
• Lee SJ
• Kim J

• KMID: 1956517
• DOI: http://doi.org/10.3340/jkns.2014.56.2.141

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.

Keyword

Cervical trauma; Delayed infarction; Vertebral artery injury

MeSH Terms

Accidents, Traffic
Brain Infarction*
Cerebellum
Cerebral Angiography
Dizziness
Headache
Humans
Infarction
Middle Aged
Occipital Lobe
Quadriplegia
Spinal Cord Compression
Vertebral Artery*

Figure

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  Fig. 1 Lateral plain X-ray on the first day showing cervical fracture-dislocation at the C3-4 level (A). T2-weighted MRI on the first day showing spinal cord compression in the sagittal view (B) and bilateral vertebral artery occlusion at the C4 level in the axial view (C).

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  Fig. 2 Postoperative plain X-ray showing anterior and posterior fixation of the cervical spine at the C3-4 level in the lateral view.

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  Fig. 3 Diffusion-weighted MRI on the 5th postoperative day showing infarctions in the left occipital lobe (A) and the left cerebellar hemisphere (B).

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  Fig. 4 CT angiography on the 5th postoperative day showing bilateral vertebral artery occlusion.

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  Fig. 5 Cerebral angiography on the 5th postoperative day showing complete occlusion of the bilateral vertebral artery, left (A) and right (B); collateral flows via the occipital arteries, left (C) and right (D).

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