No To Shinkei. 2003 Feb; 55(2): 141-5.

[Vertebral artery occlusion following neck trauma: report of two cases]

Urakawa M, Ueda Y, Yasuda H, Yamashita T.

Department of Neurosurgery, Ogori Daiichi General Hospital, Japan.

We are reporting two cases of vertebral artery occlusion resulting from cervical spine trauma. A 41-year-old man experienced vertigo and nausea 6 hrs after chiropractic manipulation. On admission, he was alert and demonstrated nystagmus, hypalgia of left leg, and right Horner sign. A MR image revealed infarction in the right cerebellar hemisphere. A MR angiogram did not show the proximal part of the right vertebral artery. A right vertebral angiogram revealed right vertebral artery occlusion at the level of C 1. He underwent anticoagulation and wore a cervical collar. He was discharged with hypalgia of left leg. A 53-year-old man was admitted to our hospital after an automobile accident. A CT scan revealed a subarachnoid hemorrhage and an intraventricular hemorrhage. A cervical CT scan revealed fractures of the C 5 facet joint and C 6 vertebral body. A MR angiogram did not show the proximal part of the left vertebral artery. A subsequent left vertebral angiogram revealed left vertebral artery occlusion at the level of C 6. He underwent anticoagulation and wore a cervical collar. In addition, he underwent coil embolization of the left vertebral artery. He was discharged with no neurological deficits. It is said that traumatic vertebral artery injuries cause cerebral infarction with time lags. The therapeutic point is to prevent propagation of the thrombus and distal embolism; therefore wearing a collar, anticoagulation, and endovascular interventional therapy is recommended.