Traumatic vertebral artery dissection
Motor vehicle collision at high speed. Neck pain.
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Filling defect and dissection flap in the left V1 segment just proximal to the vertebral artery entry into the left C6 transverse foramen. Distally there is poor opacification, with no opacification of the V3 and proximal V4 segment. Contralateral opacification of the distal V4 segment from the right, with poor but some opacification of the left PICA. Basilar artery opacifies normally. No cervical spine fracture.
Blunt cerebrovascular injury is uncommon, occurring in approximately 1% of traumas. The cervical portion (V1 segment) is the most vulnerable part of the vertebral artery. These injuries are mostly (70%) associated with cervical spine fracture. Treatment (antiplatelet/anticoagulation) is often complicated by the presence of other traumatic injuries.