Brainstem Infarct Due to Traumatic Basilar Artery Entrapment Caused by Longitudinal Clival Fracture

García-García, Jorge; Villar-Garcia, Miguel; Abad, Lorenzo; Segura, Tomás

doi:10.1001/archneurol.2011.1155

Cited by 16 publications

(6 citation statements)

References 4 publications

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“…Four patients have received anti-coagulant or anti-platelet treatment. 1 , 10 , 11 , 16) Although none of these patients demonstrated deterioration after medication, its effect is unclear in this small number. In addition, anti-thrombotic treatment in trauma patients is sometimes risky.…”

Section: Discussionmentioning

confidence: 77%

Endovascular Intervention in Basilar Artery Entrapment within the Longitudinal Clivus Fracture: A Case Report

Kanamori

Yamanouchi

Kano

et al. 2018

Neurol. Med. Chir.(Tokyo)

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Although vascular complications after head trauma is well recognized, basilar artery entrapment within the longitudinal clivus fracture is rare. A 69-year-old man presented with progressive disturbance of consciousness and right hemiplegia after trauma. Computed tomography scan showed a right-sided acute subdural hematoma and multiple skull fractures, including a longitudinal clivus fracture. Magnetic resonance imaging revealed basilar artery occlusion and a small infarction at the ventral part of the pons. On the assumption of acute arterial occlusion caused by thrombus, endovascular thrombectomy was attempted, but resulted in perforation. After the procedure, basilar artery entrapment within the longitudinal clivus fracture turned out to be the cause of the occlusion. The present case suggests that basilar artery entrapment within the longitudinal clivus fracture is a possible cause of neurological deficits after trauma. In this subset, endovascular intervention without a correct diagnosis of this phenomenon is high risk.

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Section: Discussionmentioning

confidence: 77%

Endovascular Intervention in Basilar Artery Entrapment within the Longitudinal Clivus Fracture: A Case Report

Kanamori

Yamanouchi

Kano

et al. 2018

Neurol. Med. Chir.(Tokyo)

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“… 25) In our review, four cases including our case were alert at admission (GCS 14 or 15). 1 , 3 , 16) Two cases, however, developed consciousness disturbance and proceeded to a locked-in state. 1) Even in the absence of clinical signs, if there are equivocal findings, early evaluation of cerebral blood flow such as DSA is needed.…”

Section: Discussionmentioning

confidence: 98%

“…Three cases with good neurological outcome (completely recovered or mild left hemiparesis) were diagnosed as basilar artery entrapment on the first day and started treatment. 3 , 5 , 16) In previous case reports, bifrontal decompressive craniectomy 13) or external ventricular drainage 17) has been performed to control elevated intracranial pressure caused by the infarction. There are no reports, however, of direct surgical or endovascular treatment for basilar artery entrapment.…”

Section: Discussionmentioning

confidence: 99%

Traumatic Basilar Artery Entrapment without Longitudinal Clivus Fracture: A Case Report and Review of the Literature

Yamaoka

Miyata

Bunya

et al. 2018

Neurol. Med. Chir.(Tokyo)

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In blunt cerebrovascular injury, reported traumatic basilar artery occlusions have involved dissection of the basilar artery, distal embolization due to traumatic vertebral artery dissection, or entrapment of the basilar artery into the clivus fracture. To date, however, there are no reports of traumatic basilar artery entrapment without a clivus fracture. Here, we report the first case of traumatic basilar artery occlusion caused by entrapment into an originally existing bone defect. A 67-year-old man with a history of treatment for intracranial aneurysm suffered multiple traumatic injuries in a fall. On arrival at our hospital, he presented with neurogenic shock with quadriplegia. Computed tomography (CT) showed small epidural hematoma, C4-6 cervical spinous process fracture, and Th2-3 vertebral body fracture. CT angiography revealed occlusion of the basilar artery trunk. As vertebrobasilar artery dissections and clivus fracture were not observed; however, we could not elucidate the pathology of the basilar artery occlusion. On day 4, after surgery for the cervical and thoracic lesions, he exhibited consciousness disturbance. Diffusion-weighted imaging on day 5 showed hyperintensities in the brainstem and cerebellum. Basi-parallel anatomic scanning magnetic resonance imaging showed that the basilar artery, while lacking vascular wall injuries, was tethered into the clivus. Antithrombotic therapy was performed, but the patient progressed to a locked-in state. Previous head CT before the trauma revealed a bone defect already present in the clivus. We speculated basilar artery entrapment into this preexisting bone defect. We must look for basilar artery injury in trauma patients even in the absence of clivus fracture.

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“…Cases of infarction of the posterior cerebral artery circulation which arise a result of entrapment of the basilar artery in a fracture of the clivus have been reported in the medical literature in radiology, neurosurgery, and emergency medicine journals from as far back as 1964 to the present (2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15).…”

Section: Discussionmentioning

confidence: 99%

Fatal Entrapment of the Basilar Artery in a Longitudinal Fracture of the Clivus Due to Head Injury: A Case Report and Review of the Literature

Walker

Santos

Glikstein

et al. 2017

Academic Forensic Pathology

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Infarction of the posterior cerebral artery circulation arising from entrapment of the basilar artery in a fracture of the clivus has been reported in the medical literature, predominantly in the radiology and emergency medicine journals. Review of the medical literature on the topic revealed 14 published cases of entrapment of the basilar and/or vertebral artery within a longitudinal fracture of the clivus. These were all reported between 1964 and 2016 and postmortem examination had been conducted on seven cases. To date, no case of entrapment of the basilar and/or vertebral artery in a fracture of the clivus has been reported in the forensic pathology literature, and the published literature on the entity is reviewed.

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Brainstem Infarct Due to Traumatic Basilar Artery Entrapment Caused by Longitudinal Clival Fracture

Cited by 16 publications

References 4 publications

Endovascular Intervention in Basilar Artery Entrapment within the Longitudinal Clivus Fracture: A Case Report

Endovascular Intervention in Basilar Artery Entrapment within the Longitudinal Clivus Fracture: A Case Report

Traumatic Basilar Artery Entrapment without Longitudinal Clivus Fracture: A Case Report and Review of the Literature

Fatal Entrapment of the Basilar Artery in a Longitudinal Fracture of the Clivus Due to Head Injury: A Case Report and Review of the Literature

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