Vertebral Artery Injury Laceration

Blunt trauma to the neck can cause severe injury to the vertebral arteries. The upper third of the cervical region is the area where the vertebral artery is most susceptible to trauma. Two types of trauma can result. In the most common form, there is a traumatically induced dissection in the vessel wall, along a length of vertebral artery, with rupture into the subarachnoid space at the base of the brain (Figure 6.14). The second type of injury also involves dissection but, instead of rupture of the vessel wall, there is thrombosis of the lumen with infarction of brain tissue. Opeskin and Burke reported on 25 cases of vertebral artery trauma.37 In 19 cases, there was rupture with subarachnoid hemorrhage, while in four, there was thrombosis with ischemia. The remaining two cases had rupture, but death was too rapid for subarachnoid hemorrhage.

The most common causes of vertebral artery trauma are blows to the neck, motor vehicle accidents, falls, and cervical spine manipulation. In most of Opeskin and Burke's cases, considerable force was involved.37 Chiropractic manipulation with resultant vertebral artery injury was the cause for two of their deaths. Injury of the vertebral artery should be suspected when an individual collapses and dies almost immediately after receiving a blow to

Figuren 6.14 Massive subarachnoid hemorrhage secondary to laceration of vertebral artery.

the neck. In cases caused by rupture of the artery, an autopsy reveals sub-arachnoid hemorrhage primarily concentrated on the ventral surface of the brain and around the brain stem.

In rupture of the artery due to blunt trauma, Opeskin and Burke noted bruising and abrasions below and behind the ear in 50% of 18 cases.36 Fractures of the cervical spines were present in 10 of 25 cases. Demonstration of the vertebral artery injury is easiest by injection of radio-opaque dye into the vertebral arteries with radiological demonstration of the injury. Only after such demonstration should there be dissection of the neck, because dissection is extremely difficult and, if not done correctly, may produce artifactual defects in the vessels.

Of 19 individuals with rupture and subarachnoid hemorrhage in the study of Opeskin and Burke, 14 died immediately and five in 10 h to 3 days.37 Four of the five delayed deaths were unconscious from the time of trauma. In the fifth case, rupture occurred 2-3 days after neck manipulation. Of the four individuals who died secondary to vertebral artery thrombosis, symptoms did not appear for 1 d to 4 weeks, with survival time of 3 days to 7 weeks.

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