by Polina Osler, Philippe Phan, and Brian Grottkau
Aspirin Versus Heparin for Management of Cerebellar Stroke After Vertebral Artery Dissection Following C1-C2 Fracture-Dislocation by Polina Osler, Philippe Phan, and Brian Grottkau JBJS Case Connect Volume 4(3):e67 August 13, 2014 2014 by The Journal of Bone and Joint Surgery, Inc. Figs. 1-A through 1-F CT of the cervical spine showing the C1-C2 vertebral fracture-dislocation.
Figs. 1-A through 1-F CT of the cervical spine showing the C1-C2 vertebral fracture-dislocation. Figs. 1-A and 1-B Neck CT prior to reduction. The severity of the rotatory deformity can be seen on the three-dimensional CT reconstructions. The overlapping axial CT reconstructions show the C1 and C2 vertebrae with the fracture of the left facet (arrow) prior to reduction (Figs. 1-C and 1-D) and after reduction (Figs. 1-E and 1-F) Polina Osler et al. JBJS Case Connect 2014;4:e67 2014 by The Journal of Bone and Joint Surgery, Inc. Figs. 2-A through 2-F The CT angiogram and the MR angiogram of the head and neck show occlusion of the left vertebral artery. Figs. 2-A through 2-F The CT angiogram and the MR angiogram of the head and neck show occlusion of the left vertebral artery. Normal anatomy of the circle of Willis can be visualized on the MR angiogram of the head with both the right and left vertebral arteries visible (Fig. 2-A, arrow marked with asterisk indicates the normal appearance of the left vertebral artery). The MR angiogram of the head shows a normal right vertebral artery but the left vertebral artery is not visualized; the arrows point to the location where it would be expected to be seen (Figs. 2-B and 2-D). Axial CT reconstruction of the C1-C2 complex after reduction (Fig. 2-C) shows the arch of the right vertebral artery (RVA) with the contrast-filled lumen, but the left vertebral artery (LVA) is not visualized; the arrow points to the location where it would be expected to be seen. There is a filling defect in the left vertebral artery from the point of the dural penetration to the origin of the posterior inferior cerebellar artery. Finally, sagittal CT reconstructions show the segment of the right vertebral artery entering the skull (Fig. 2-E) and the presumed location of the corresponding left segment (arrow), which is not visualized due to occlusion (Fig. 2-F). Polina Osler et al. JBJS Case Connect 2014;4:e67 2014 by The Journal of Bone and Joint Surgery, Inc. Figs. 3-A through 3-F MRI of the brain shows the acute cerebellar infarct.
Figs. 3-A through 3-F MRI of the brain shows the acute cerebellar infarct. Axial MR images taken at the level of the upper medulla (top row) and the pontomedullary junction (bottom row) show evidence of acute cerebellar infarction affecting both lateral cerebellar hemispheres (large arrows) and the left medulla (small arrows). Areas of acute ischemia appear bright on the diffusion weighted imaging sequence (Figs. 3-A and 3-B) and dark on the corresponding apparent diffusion coefficient sequence images (Figs. 3-C and 3-D). After six hours, damaged areas can be seen on the T2-weighted fluid-attenuated inversion recovery images as areas of increased signal intensity (Figs. 3-E and 3-F). Polina Osler et al. JBJS Case Connect 2014;4:e67 2014 by The Journal of Bone and Joint Surgery, Inc. At the twelve-month follow-up, CT and CT angiography of the cervical spine showed near perfect alignment of C1 and C2 on the axial reconstructions (left panel); the left vertebral artery (LVA) lumen appears narrowed (arrow, right panel) compared with the ap... At the twelve-month follow-up, CT and CT angiography of the cervical spine showed near perfect alignment of C1 and C2 on the axial reconstructions (left panel); the left vertebral artery (LVA) lumen appears narrowed (arrow, right panel) compared with the appearance of the right vertebral artery (RVA) (middle panel). Polina Osler et al. JBJS Case Connect 2014;4:e67 2014 by The Journal of Bone and Joint Surgery, Inc.