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A 31-year-old man following motor vehicle collision, was admitted to the Emergency Medicine Department of Clinic of Traumatology „ Sestre milosrdnice” University Hospital Center, Croatia, presented with C2-3 fracture dislocation, manifesting with quadriparesis and hypoesthesia below his C3 cord level (including phrenic nerve paralysis), and bowel and bladder dysfunction. This is a serious injury and may cause respiratory failure due to the involvement of phrenic nerve area and thus paralyzing the diaphragm.. The patients needed ventilatory support and aggressive resuscitation measures. He was rapidly intubated and after initial trauma evaluation, the patient was hemodynamicallystable and taken for imaging. Initial computed tomography (CT) scan of brain was normal, while CT and Magnetic resonance imaging (MRI) of the cervical spine showed C2-3 intervertebral disc injury. Figure: 2 Anterior vertebral fusion C2-C3 (spondylodesis) was done. Figure: 3 Postoperatively he developed nausea, dizziness, with oculomotor disorders -nystagmus. Suspicion of cerebellar stroke has been raised. On CT brain scan infratneorially dominated by bihemispheric predominantly left acute ischemic cerebellar changes with slightly wider IV chamber. Figure 4, 5. Suspected vertebral artery injury referred for CT angiography. Final diagnosis of dissection of left vertebral artery was made in CT angiography. CT angiography of the head and neck revealed the dissection of the left vertebral artery in the V2 segment, while the intracranial part is shown as well as the left "PICA" . Right vertebral artery was altered physiological course in the postoperative area, surrounded by a hematoma. Figure 6. His injured vertebral artery was treated conservatively, with antiplatelet and anticoagulation therapy which did not cause any other ischemic complications with good outcome. After halo immobilization, surgical stabilization, and medical treatment the patient was discharged and at his eight- month follow up he was with mild neurological symptoms. Screening for the dissection of VA s important in patients with cervical spine trauma in order to ensure adequate treatment. Although the treatment strategy described here could yield good results, it may require modification according to the needs of the individual patient. In conclusion, vertebral artery dissection associated with cervical spine trauma has the potential for neurological ischemic events like vertebrobasilar stroke. |
