Abstract
Vertebral arterial injury caused by blunt cervical trauma is a rare clinical entity. This condition usually results in vertebrobasilar circulation insufficiency due to the occlusion of the damaged vertebral arterial trunk. Here we reporta case of vertebral artery brunch bleeding associated with closed head trauma, with leading to severe respiratory disturbance. We speculate that a possible hyperextension/flexion injury of the neck led to the vertebral arterial branch rupture and neck swelling.An 81-year-old man was transferred to our emergency room due to deterioration of consciousness level after head trauma. On admission, neurological examination revealed consciousness disturbance. The patient had respiratorydifficulties with stridor. Laryngoscopy immediately performed showed obstruction of trachea because of the swelling of retropharyngeal wall. Cricothyroid puncture was performed but ineffective. Therefore, emergency tracheostomy was performed. The neck computed tomography revealed retropharyngeal hematoma without vertebral bone fractures. Cervical angiography showed the extravasation of a vertebral artery branch that supplied the soft tissue anterior to C3.After the conservative therapy in the intensive care unit, the patient left our hospital without any neurological deficit on the 40th-hospital day. In this case, we suppose a possible mechanism that the neck hyperextension/flexion damaged the vulnerable artery branch.
