J Korean Soc Emerg Med.  2017 Apr;28(2):213-217. 10.0000/jksem.2017.28.2.213.

Top of the Basilar Syndrome after 2nd Cervical Spine Fracture

• Kim SP
• Sun KH
• Kim SJ
• Kim TH

• KMID: 2379831
• DOI: http://doi.org/10.0000/jksem.2017.28.2.213

Abstract

Top of the basilar (TOB) syndrome occurs with occlusion of the rostral portion of the basilar artery that supplies blood to the midbrain, thalamus, and temporal and occipital lobes. Symptoms associated with TOB include decreased alertness, abnormal eye movement, dysarthria, and disorders of cerebellar function. A 47-year-old man was transferred to our hospital to manage C2 vertebral fracture sustained in a traffic accident. He was alert on arrival; however, he lapsed into semicoma. He was diagnosed with TOB. Thrombolytic agents could not be administered due to a contraindication in cervical spine fracture. Brain magnetic resonance imaging showed acute infarction of the pons, cerebellum, and posterior cerebral artery territory. This rare case demonstrates that C2 vertebral fracture can result in TOB.

Keyword

Brain stem infarctions; Spinal fractures; Unconsciousness

MeSH Terms

Accidents, Traffic
Basilar Artery
Brain
Brain Stem Infarctions*
Cerebellum
Dysarthria
Equipment and Supplies
Eye Movements
Fibrinolytic Agents
Humans
Infarction
Magnetic Resonance Imaging
Mesencephalon
Middle Aged
Occipital Lobe
Pons
Posterior Cerebral Artery
Spinal Fractures
Spine*
Thalamus
Unconsciousness
Fibrinolytic Agents