Citation

Irawany V, Nasution VAF, Amalia N. J. Med. Case Reports 2024; 18(1): e106.

Copyright

(Copyright © 2024, Holtzbrinck Springer Nature Publishing Group - BMC)

DOI

10.1186/s13256-024-04432-3

PMID

38491407

PMCID

PMC10943836

Abstract

BACKGROUND: Vertebral artery injury is a rare condition in trauma settings. In the advanced stages, it causes death. CASE: A 31-year-old Sundanese woman with cerebral edema, C2-C3 anterolisthesis, and Le Fort III fracture after a motorcycle accident was admitted to the emergency room. On the fifth day, she underwent arch bar maxillomandibular application and debridement in general anesthesia with a hyperextended neck position. Unfortunately, her rigid neck collar was removed in the high care unit before surgery. Her condition deteriorated 72 hours after surgery. Digital subtraction angiography revealed a grade 5 bilateral vertebral artery injury due to cervical spine displacement and a grade 4 left internal carotid artery injury with a carotid cavernous fistula (CCF). The patient was declared brain death as not improved cerebral perfusion after CCF coiling.

CONCLUSIONS: Brain death due to cerebral hypoperfusion following cerebrovascular injury in this patient could be prevented by early endovascular intervention and cervical immobilisation.

Language: en

Keywords

Carotid artery injury; Cerebrovascular trauma; Cervical vertebrae; Digital subtraction angiography; Spondylolisthesis