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Incidence of Traumatically Induced Vertebral Artery Occlusion Associated with Cervical Spine Injuries: Prospective Study Using Magnetic Resonance Angiography

K. Sudhakar1, R. Manimaran2, Dhanesh Kumar Kasinathan3, Bipin Chaurasia4 , K. Sudhakar1 , R. Manimaran2 , Dhanesh Kumar Kasinathan3 , Bipin Chaurasia4

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International Journal of Neurology and Neurosurgery 10(3):p 242-251, Jul-Sep 2018. | DOI: DOI: http://dx.doi.org/10.21088/ijnns.0975.0223.10318.16

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Abstract

Background: Although the vertebral artery injuries (VAI) associated with cervical spine trauma are usually clinicallyoccult, they may cause fatal ischemic damage to the brain stem and cerebellum. Methods: We performed a prospective study using magnetic resonance angiography (MRA) to determine the frequency of VAI associated with cervical spine injuries and investigate the clinical and radiological characteristics. Between August 2011 TO January 2017, 108 consecutive patients with cervical spine fractures and/or dislocations were prospectively evaluated for patency of the VA, using the MRA, at the time of injury. Results: Complete disruption of blood flow through the VA was demonstrated in twenty two patients with unilateral occlusion in 20 patients (18.3%). There were 20 men and 4 women with a mean age of 45 (range, 24 ­50 years). Unilateral occlusion of the right and left vertebral artery occurred in 10 patients and of bilateralin 4. Regarding the cervical injury type, Distraction/extension, distraction/flexion, and lateral flexion injuries were the major mechanisms of injury. Dissection and occlusion were the frequent vascular injury patterns. Facet joint dislocations and the fractures extending into the transverse foramen were the spine injury patterns closely associated with VAI. All patients presented with good patency of the contralateral VA. None of the patients developed secondary neurological deterioration due to vertebrobasilar ischemia during the follow­up period with a mean duration of 60 months. Conclusions: VAI should be suspected in patients with cervical trauma that have cervical spine fractures and/or dislocations or transverse foramen fractures.

Keywords: Cervical Spine; Computed Tomographic Angiography; Injury; Vertebral Artery

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DOI: DOI: http://dx.doi.org/10.21088/ijnns.0975.0223.10318.16

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