Presentation
Young patient brought to the emergency department with a low level of consciousness after a high-speed car accident.
Patient Data
The basion-dens interval is augmented concerning with a craniocervical dissociation with an associated extensive prevertebral hematoma. There is consequent irregular contrast extravasation surrounding the basilar artery in keeping with a transection injury. Related diffuse and thick subarachnoid hemorrhage predominantly in the suprasellar and prepontine cisterns with intraventricular extension can be observed. Additionally, poor grey-white matter differentiation on the basal ganglia regions bilaterally is seen, translating diffuse incipient cerebral edema. Also note diffuse narrowing and subtle irregularity of intracranial arteries in line with secondary cerebral vasoconstriction. Status post intubation, nasopharyngeal tube in situ with small amount of fluid in its distal opening.
Annotated images show the augmented basion-dens interval (yellow dashed line) in the first panel, and the extensive prevertebral hematoma (red free form) in the second panel.
Case Discussion
The patient did not survive those injuries and unfortunately died a few hours later.
This is a very unusual case, as the more frequent blunt cerebrovascular injuries affect the cervical portion of the internal carotid arteries and/or the vertebral arteries. Trauma damage to the basilar artery is extremely rare because it has an intracranial path, and only a few cases are reported.
This case is submitted in collaboration with Dr. Nerses Nersesyan.
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