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Case Reports in Neurological Medicine
Volume 2015, Article ID 571656, 5 pages
http://dx.doi.org/10.1155/2015/571656
Case Report

Fatal Vertebral Artery Injury in Penetrating Cervical Spine Trauma

1Boston University Medical Center, 840 Harrison Avenue, Dowling 2 North, Orthopaedic Administration, Boston, MA 02118, USA
2Boston Medical Center, Boston, MA 02118, USA

Received 4 July 2015; Revised 15 October 2015; Accepted 18 October 2015

Academic Editor: Hidetoshi Ikeda

Copyright © 2015 Chadi Tannoury and Anthony Degiacomo. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Study Design. This case illustrates complications to a vertebral artery injury (VAI) resulting from penetrating cervical spine trauma. Objectives. To discuss the management of both VAI and cervical spine trauma after penetrating gunshot wound to the neck. Summary of Background Data. Vertebral artery injury following cervical spine trauma is infrequent, and a unilateral VAI often occurs without neurologic sequela. Nevertheless, devastating complications of stroke and death do occur. Methods. A gunshot wound to the neck resulted in a C6 vertebral body fracture and C5–C7 transverse foramina fractures. Neck CT angiogram identified a left vertebral artery occlusion. A cerebral angiography confirmed occlusion of the left extracranial vertebral artery and patency of the remaining cerebrovascular system. Following anterior cervical corpectomy and stabilization, brainstem infarction occurred and resulted in death. Results. A fatal outcome resulted from vertebral artery thrombus propagation with occlusion of the basilar artery triggering basilar ischemia and subsequent brainstem and cerebellar infarction. Conclusions. Vertebral artery injury secondary to cervical spine trauma can lead to potentially devastating neurologic sequela. Early surgical stabilization, along with anticoagulation therapy, contributes towards managing the combination of injuries. Unfortunately, despite efforts, a poor outcome is sometimes inevitable when cervical spine trauma is coupled with a VAI.