Case 31 - Facet Fracture, Vertebral Artery Occlusion

Dr. Yousem has provided the following report as a sample report for your reference. It does not match the case reviewed in the video.

Indication: Cervical spine fracture C4-5 facet and left lamina of C4 and right pedicle of C4 extending to foramen transversarium.

TECHNIQUE: CT angiographic images were performed through the neck with multiplanar reconstructions and three-dimensional maximum intensity projection reconstructions.

FINDINGS:

The origin of the left common carotid artery is normal in appearance. The carotid bifurcation shows no significant stenosis. The petrous and cavernous portions of the left internal carotid artery are unremarkable.

The right common carotid artery origin is normal in appearance. The carotid bifurcation is normal as well. The petrous and cavernous portions of the right internal carotid artery are unremarkable.

The left vertebral artery is small in size. It has a normal V1 segment. Within the intervertebral V2 segment the flow within the vessel is not seen beginning at the C5-6 disc level to the C3-4 disc level within the foramen transversarium. Above this level there is diminution in the visualization of the V4 segment of the left vertebral artery.

The right vertebral artery origin shows atherosclerotic change. The the A1 segment of the right vertebral artery is incompletely seen. The V2 segment of the right vertebral artery is not seen until the C3-4 level in the foramen transversarium. The V3 and V4 segments are visualized however.

Please see the previous studies for evaluation of the cervical spine fractures. Soft tissue swelling in the prevertebral space in the lower cervical spine right greater than left and and at the C4-5 level. Again seen is the spinal stenosis at the C4-5 level with compression of the spinal cord in the facet widening.

IMPRESSION:

Absence of visualization of both vertebral arteries from the C5-6 level to the C3-4 level on the left side and from the vertebral artery origin to the C3-4 level on the right side compatible with traumatic occlusion/dissection. The vessels are reconstituted at the C3-4 level with poor visualization of the left intracranial vertebral artery.

Otherwise the vasculature is unremarkable. Please see the previous studies for the description of the cervical spine fractures.