Traumatic Basilar Artery Occlusion Caused by a Fracture of the Clivus. Case Report.

Abstract

A 56-year-old man presented with a rare traumatic basilar artery occlusion caused by a fracture of the clivus. He fell from the height of 2 meters and immediately fell into a coma. Head computed tomography (CT) revealed an open depressed fracture, an acute epidural hematoma 1 cm thick in the left middle frontal fossa, and a longitudinal fracture of the clivus. Emergency removal of the hematoma was performed with cranioplasty. Head CT 8 hours 50 minutes after injury showed infarctions in the brain stem, cerebellum, and occipital lobes. Cerebral angiography revealed occlusion of the basilar artery in the middle part of the clivus. The patient died after 3 days. Autopsy revealed that the basilar artery was trapped in the clivus fracture site. Vertebrobasilar artery occlusion due to trapping in a clivus fracture has a very poor prognosis. Diagnosis is difficult and generally only confirmed at autopsy. Cerebral angiography is recommended in a patient in a deep coma without massive brain contusion at the early stage of head injury to identify the possibility of vertebrobasilar artery occlusion in a clivus fracture.

Subarachnoid, subdural and interdural spaces at the clival region: an anatomical study.

“…The main clinical property of traumatic clival epidural, or interdural, is that hematomas are frequently associated with low GCS levels (14,19). Severe injuries, such as, longitudinal clivus fracture, atlantoaxial dislocation, clival dural laceration and entrapment of the vertebrobasilar artery complex have been reported in these patients (5,18,19,24). In trauma cases, it is possible to mechanically peel off the clival dura mater from below to above, by distraction of the dens towards the superior direction.…”

Traumatic Longitudinal Clival Fracture in a Child -Case Report-

“…Longitudinal clival fractures in adults were caused by frontal impact in 10 cases, 2,3,5,7,10,11,16-18) axial impact in 2 cases, 1,15) posterolateral impact in 1 case, 7) and occipital impact in 3 cases, 7,9,14) indicating the high number of cases of frontal impact in adults. All reported patients with occipital impact had occipital fractures.…”

“…Traumatic severe brain damage is often discovered in addition to brain stem damage or vascular accident in patients with clivus fracture. 3,7,[12][13][14][15]18) Our case also illustrates the frontal contusion and traumatic subarachnoid hemorrhage which are regarded as the factors which cause the initial unconsciousness after an occiput impact.…”

“…3) A total of 51 cases of fractures of the clivus due to head injury have been reported, mostly in adults who suffered serious vascular and cranial nerve damage. [1][2][3][4][5][7][8][9][10][11][12][13][14][15][16][17][18] Longitudinal clival fractures were identified in 29 cases, including four in children.…”

Bilateral anterior cerebral infarcts from a depressed anterior base of skull fracture: Case report and review of the literature

“…5,11 Direct intracranial vascular trauma is a rare manifestation of injury although involvement of the Circle of Willis should be considered in association with fractures through the clivus or when internal carotid artery dissection is suspected. 14,20,22,25,29 Fractures through the sella turcica may also involve its resident pituitary gland as well as potential optic nerve damage at the level of the optic chiasm. Usually greater forces are involved for this type of damage to occur and therefore more extensive intracranial vascular involvement should be considered.…”