C2 fracture with vertebral artery dissection

Case contributed by Dr Craig Hacking

Presentation

MVA, neck pain.

Patient Data

Age: 85
Gender: Female

A comminuted and minimally displaced fracture extends through the base of the odontoid process and body of C2 into the right lateral mass, involving the right transverse foramen. The left lateral mass is preserved. The tip of the odontoid process maintains its articulation with the anterior arch of C1. There is no retropulsed osseous component. No further cervical spine fracture is identified. Background diffuse osseous demineralization and multilevel degenerative change.

There is gross enlargement of the right thyroid lobe containing multiple nodules but no evidence of tracheal compression.

Conclusion

Unstable C2 fracture extending through the base of the odontoid, involving the body, right lateral mass and extending into the right sided neural foramen - a type 3 fracture. CTA is recommended to assess for possible vertebral artery injury.

There is a fracture at the level of C2 involving the right transverse process and the base of the odontoid process.

There appears to be a subtle linear filling defect within the horizontal portion of the right vertebral artery at the level of C2 concerning for a dissection flap.

The left vertebral artery is tortuous but otherwise normal. The internal and external carotid arteries are opacify normally. No significant stenosisis seen. The arteries comprising the circle of Willis are incomplete; the left ICA supplies both ACAs and the left MCA, the right ICA supplies the right MCA.

Conclusion

Suspected tiny dissection flap within right vertebral artery at site of C2 transverse fracture.

Case Discussion

Any fracture involving a foramen for a vessel should be assessed with CTA.

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Case information

rID: 37378
Case created: 5th Jun 2015
Last edited: 28th Sep 2016
Inclusion in quiz mode: Included

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