case: cerebrovascular trauma

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Caesar

Coil embolize the affected vertebral - seen a number of cases of late
false anuerysm and embolisation.

Tim
Dr T C Hardcastle
M.B., Ch.B. (Stell); M. Med. (Chir) (Stell); FCS (SA)
Principal Specialist Trauma Surgeon /
Honorary Lecturer UKZN Dept Surgery
Deputy Director - IALCH Trauma Service

> 20-ish male restrained driver crashes head on into palm tree (yes,
> really).
> no airbags, but restrained by lap and shoulder harness.
>
> Intoxicated but cooperative.
> Complaining of neck pain only.
>
> Hemodynamically normal on arrival and subsequently.
> Neck exam:  bruise across right neck in the usual location from the
> restraint belt.  Tender posterior neck.
> Neurologic exam: normal.
>
> CT scan of cervical spine:  fractured c-5 body and lamina, 3mm c-5 on c-6
> anterior subluxation.  No significant soft tissue abnormalities.
> CT Angio of neck: right vertebral artery focally stenotic at c-6 but
> patent.
> all other vessels are normal.
> CT of brain (noncontrast): normal
> MRI of c-spine: no ligamentous damage; right vertebral artery with small
> clot and intimal dissection, but patent.
>
> Neurosurgeon wants to stabilize his fractured c-spine (i.e. operate).
> This
> will be done via anterolateral approach.
>
> Plan?
>
> C. Ursic, MD
> general surgeon
>
>
>
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>
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> Is the knowledge of our own ignorance.'
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