Document Detail

Distal Embolic Brain Infarction Due to Recanalization of Asymptomatic Vertebral Artery Occlusion Resulting From Cervical Spine Injury: A Case Report.
MedLine Citation:
PMID:  25435840     Owner:  NLM     Status:  Publisher    
OBJECTIVE: The purpose of this case report is to describe a patient with brain infarction due to recanalization of an occluded vertebral artery (VA) following closed reduction and open fixation of cervical spinal dislocation and to discuss the management of asymptomatic VA injuries associated with spine trauma.
CLINICAL FEATURES: A 41-year-old Asian man experienced a C4-5 distractive-flexion injury manifesting with quadriplegia and anesthesia below the C3 cord level (including phrenic nerve paralysis), and bowel and bladder dysfunction. Magnetic resonance angiography and computed tomography angiography showed left extracranial VA (V2) occlusion and a patent contralateral VA.
INTERVENTION AND OUTCOME: The patient was observed without antiplatelet and/or anticoagulation therapy and underwent open reduction and internal fusion of C4/5 and tracheostomy 8 hours after the injury. After surgery, supraspinal symptoms such as left horizontal nystagmus and left homonymous hemianopsia led to cranial computed tomography and magnetic resonance imaging, which showed left-side cerebellar infarction in the posterior inferior cerebellar artery territory and right-side posterior cerebral artery infarction. Magnetic resonance angiography and computed tomography angiography demonstrated patent bilateral VA (but hypoplastic right VA) and occluded right posterior cerebral artery. The injured VA was treated conservatively, and there were no other ischemic complications.
CONCLUSION: The management of asymptomatic VA injury is controversial, with several treatment options available, including observation alone, antiplatelet therapy, anticoagulation therapy, or invasive intervention. Although there are some reports described where management with observation alone seems safe, serious attention should be given to the VA injury caused by cervical spine trauma.
Yaoki Nakao; Hiroshi Terai
Publication Detail:
Journal Detail:
Title:  Journal of chiropractic medicine     Volume:  13     ISSN:  1556-3707     ISO Abbreviation:  J Chiropr Med     Publication Date:  2014 Dec 
Date Detail:
Created Date:  2014-12-1     Completed Date:  -     Revised Date:  2014-12-2    
Medline Journal Info:
Nlm Unique ID:  101163637     Medline TA:  J Chiropr Med     Country:  -    
Other Details:
Languages:  ENG     Pagination:  266-272     Citation Subset:  -    
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