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

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.

Antiplatelet Versus Anticoagulation for Asymptomatic Patients with Vertebral Artery Injury During Anterior Cervical Surgery—Two Case Reports and Review of Literature

“…According to the literature, anticoagulant management post VAI has traditionally led to hemodynamic stabilization [5][6][7].…”

“…Conversely, in another study by Colella et al [13], 9 patients with mural carotid injury were treated with antiplatelet therapy resulting in 8 (88%) patients recovering neurologically without deficits. Jang et al [7] conducted a study to evaluate the management of asymptomatic VAO in 8 patients needing cervical fracture surgery. Five of 8 (62%) patients were treated by observation alone while 2 of 8 (25%) patients were treated with aspirin post-operatively, all making a complete recovery without heparin use [7].…”

“…Jang et al [7] conducted a study to evaluate the management of asymptomatic VAO in 8 patients needing cervical fracture surgery. Five of 8 (62%) patients were treated by observation alone while 2 of 8 (25%) patients were treated with aspirin post-operatively, all making a complete recovery without heparin use [7].…”

Delayed Infarction of Medullar and Cerebellum 3 Months after Vertebral Artery Injury with C1-2 Fracture: Case Report

“…It is reported that about 2% of all trauma patients, 20% of head injured patients, from 13% to 46% of blunt cervical trauma, and 7% of cervical fractures are VAI 48). Bilateral VAI are estimated to occur at approximately 10% of the frequency of unilateral VAI 7). Clinical considerations are needed because posterior circulatory ischemia may result.…”

“… 4 8) Bilateral VAI are estimated to occur at approximately 10% of the frequency of unilateral VAI. 7) Clinical considerations are needed because posterior circulatory ischemia may result.…”