Bilateral vertebral artery transection following blunt trauma

Area of Science:

• Trauma surgery
• Vascular surgery
• Emergency medicine

Background:

• Blunt vertebral artery injury (BVI) is a severe complication of trauma, especially cervical spine injuries.
• Early diagnosis and treatment of blunt cerebrovascular injuries (BCVI) are crucial for favorable outcomes, except in cases of complete transection.
• Complete transection injuries of the vertebral artery have a reported 100% mortality rate, necessitating further research.

Purpose of the Study:

• To present a case of bilateral vertebral artery transection following blunt trauma.
• To discuss the implications of this rare and fatal injury on patient outcomes.
• To highlight the challenges in attributing neurologic outcomes in patients with multiple severe injuries.

Main Methods:

• A 55-year-old patient sustained a motor vehicle collision with cervical spine injury and presented with neck pain and neurological deficits.
• Initial assessment revealed an open extremity fracture, neck swelling, and decreased motor function.
• The patient experienced hemodynamic instability, underwent resuscitation, and was taken for emergent surgery, followed by CT angiography.

Main Results:

• CT angiography revealed C5-C6 dissociation, bilateral vertebral artery transection, and a prevertebral hematoma.
• The patient experienced progressive neurological decline with posterior cerebral artery infarcts.
• Brain death was confirmed, and care was withdrawn.

Conclusions:

• This case supports the high mortality rate associated with complete BCVI transections.
• Bilateral vertebral artery transection is a rare and devastating injury.
• Coexisting injuries in BCVI patients complicate the assessment of individual injury impact on neurologic outcomes.