Abstract
We describe a case (66 year-old male) of delayed onset of a left vertebral artery (VA) occlusion after blunt cervical trauma caused by an operational error when using a cultivator. Left-side neck pain and occipital headache persisted after the accident, then disappeared. Ten weeks later, the man was admitted to our hospital because of consciousness disturbance and left hemiparesis. MR angiography revealed complete left VA occlusion, and a basi-parallel anatomical scanning MRI showed the appearance of the left VA. Diffusion-weighted images showed an infarction of the territory of the left posterior inferior cerebellar artery as well as the anterior spinal artery. Hyperdense artery signs were seen from the left VA to the basilar artery on the cranial CT. Based on these findings, a diagnosis was made of VA injury, which is considered to have caused the dissection, associated with the cervical hyperextension. This case illustrates a rare cause of blunt carotid trauma. VA injury should be considered in patients presenting with persistent neck pain and occipital headache after blunt carotid trauma, even if the period from the accident to the appearance of neurological symptoms is long.
