Cervical spine fractures with vertebral artery dissection

Case contributed by Dr Henry Knipe

Presentation

Neck pain post motor vehicle collision.

Patient Data

Age: 70 years
Gender: Male

Fracture through the base of the dens, with mild posterior displacement and angulation. Posterior subluxation of C1 on C2. Right C4 superior articular pillar fracture (undisplaced) extending to the articular surface; fracture line ends up adjacent to the right vertebral artery. No central canal narrowing. Prevertebral soft tissues are within normal limits.

Right vertebral artery tapers out and is not opacified between C5 and C7. Distal to C5 there is re-opacification with irregularity of the wall. No distinction linear filling defect of a dissection flap. Distally the left V4 segment and intracranial posterior circulation opacify normally with no filling defect. Dominant left vertebral artery

Case Discussion

Trauma is the most common cause of vertebral artery dissection. V2 segment is most commonly affected, followed by V3 segment. 

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Case information

rID: 53296
Published: 11th May 2017
Last edited: 14th Aug 2019
Inclusion in quiz mode: Included

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