A rare case of brain stem infarction as a complication of cervical spine injury is reported. A 15-year-old male had sustained a cervical spine injury complicated by quadriplegia. Cervical X-ray and CT scan revealed a right facet dislocation at C4/5. Ten hours after open reduction of the dislocation, he developed cranial nerve deficits. Vertebral angiograms showed complete occlusion of the basilar artery at its origin and of the right vertebral artery. Brain MRI demonstrated infarction of the medulla and pons. The fact that a follow-up angiogram revealed intimal injury of the right vertebral artery suggested embolization of the basilar artery originating at the initial site of injury of the vertebral artery. Vertebral artery injury may be a common lesion following cervical trauma. Consequently, the possibility of secondary infarction of the brain stem or cerebellum should be taken into consideration in managing patiens with cervical spine injuries.
