Presentation
Out of hospital cardiac arrest with estimated 1 hour downtime. Normal ECG, PEA. Intubated. Fixed dilated pupils.
Patient Data
Hyperdense left vertebral artery at the lower limit of the unenhanced CT head. This was confirmed on CT angiogram, with a background dominant left vertebral supply. Reconstitution of the basilar artery at the time of imaging.
Additional significant finding of C1 and C2 fractures.
The patient did not improve in critical care, however the clinical team were unable to perform formal brain stem death tests given the high spinal fractures.
Catastrophic posterior/vertebrobasilar circulation infarct, with infarction of deep grey matter nuclei.
Other findings include pseudosubarachnoid sign and developing hydrocephalus.
Case Discussion
This case is an example of findings seen when imaging patients following cardiac arrest, especially with atypical cardiac characteristics. As well as the dominant vertebral artery dissection and significant resultant infarct, there were high unstable spinal fractures.
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