Traumatic vertebral artery dissection is a type of blunt cerebrovascular injury. It is clinically relevant due to the risk of posterior circulation ischaemia1.
Motor vehicle accidents are the most common cause of traumatic vertebral injury2. Of these cases, unilateral traumatic vertebral artery injury is symptomatic in only up to 20% of cases. This is due to the significant collateral supply of the posterior circulation.
Symptoms are largely due to compromisation of the cerebellum, brainstem and visual cortex, which includes:
- headache, dizziness, nausea and vomiting, sensory and gait distrubance as well as speech and visual abnormalities.
CT angiography is used for diagnosis. This is because it has good sensitivity, fast examination time and a decreased rate of stroke compared to digital subtraction angiography.
Management for vertebral artery dissections include:
- Conservative management - observation
- Anticoagulation - can be given to asymptomatic patients who do not have any contraindications
- Endovascular intervention - stenting, occlusion, pseudoaneurysm coil embolisation
- Open surgical management - rarely performed, but may be indicated in patients who cannot receive anticoagulation and have failed endovascular intervention
Case contributed by A/Prof. Pramit Phal.